Basic Information
| Provider Information | |||||||||
| NPI: | 1932310737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BESSAC | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | LSW, CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 HINANO ST | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967204427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085891829 | ||||||||
| FaxNumber: | 8085892610 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 HINANO ST | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085891829 | ||||||||
| FaxNumber: | 8085892610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 1641 | HI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.