| Organization Name: | ISLAND THERAPEUTIC SPECIALISTS LLC |
| NPI Number: | 1407283732 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERESA CRUZAN (CEO/DIRECTOR OF THERAPEUTIC SERVICE) |
| Mailing Address: | 81-6587 Mamalahoa Hwy Suite C-203 Kealakekua |
| State: | HI US |
| Postal Code: | 96750 |
| Phone Number: | 8089872451 |
| Fax Number: | |
| NPI Enumeration Date: | 10/01/2013 |
| NPI Last Update Date: | 05/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1663-12 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |