Provider Demographics
NPI:1962156620
Name:PACIFIC BEHAVIORAL HEALTHWORKS LLC
Entity type:Organization
Organization Name:PACIFIC BEHAVIORAL HEALTHWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLETE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-225-4377
Mailing Address - Street 1:590 FARRINGTON HWY 210
Mailing Address - Street 2:PMB 208
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-670-6850
Mailing Address - Fax:
Practice Address - Street 1:98-072 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5122
Practice Address - Country:US
Practice Address - Phone:808-431-3789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty