Doctor Name: | DR. MARK DOUGLAS BREITHAUPT |
NPI Number: | 1053436337 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | |
Business Practice Address: | 55 N Church St Ste 7 Wailuku, HI - 967931684 |
Business Phone Number: | 8082444037 |
Business Fax Number: | 8082421990 |
Mailing Address: | Po Box 2632, WAILUKU |
State: | HI |
Postal Code: | 967937632 |
Phone Number: | 8082444037 |
Fax Number: | 8082421990 |
NPI Enumeration Date: | 03/19/2007 |
NPI Last Update Date: | 02/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |