Basic Information
Provider Information
NPI: 1033559885
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FUCHTMAN
FirstName: ARI-ANNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KLECKNER
OtherFirstName: ARI-ANNE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 342091
Address2:  
City: KAILUA
State: HI
PostalCode: 967348997
CountryCode: US
TelephoneNumber: 8084263704
FaxNumber:  
Practice Location
Address1: 1822 KEEAUMOKU ST
Address2:  
City: HONOLULU
State: HI
PostalCode: 968223001
CountryCode: US
TelephoneNumber: 8085274470
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2013
LastUpdateDate: 07/14/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X345HIY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


Home