Provider Demographics
NPI:1487403226
Name:MAUI MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MAUI MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRAYCHINEAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MHC
Authorized Official - Phone:253-224-3422
Mailing Address - Street 1:14 AKEU PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8291
Mailing Address - Country:US
Mailing Address - Phone:253-224-3422
Mailing Address - Fax:
Practice Address - Street 1:14 AKEU PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8291
Practice Address - Country:US
Practice Address - Phone:253-224-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)