Basic Information
| Provider Information | |||||||||
| NPI: | 1346914801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUIANG | ||||||||
| FirstName: | MARY GRACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 WAENA ST | ||||||||
| Address2: | |||||||||
| City: | WAHIAWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967861317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082246629 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1001 KAMOKILA BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085916060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2021 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.