| Organization Name: | BAY CLINIC INC |
| NPI Number: | 1265482624 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HAROLD L WALLACE (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 15-2866 Pahoa Village Rd Bldg C Pahoa |
| State: | HI US |
| Postal Code: | 967787720 |
| Phone Number: | 8089659711 |
| Fax Number: | 8089656240 |
| NPI Enumeration Date: | 05/10/2006 |
| NPI Last Update Date: | 02/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |