Basic Information
| Provider Information | |||||||||
| NPI: | 1952432635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALOHA BEHAVIORAL CONSULTANTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 N HARRISVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844042580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013991818 | ||||||||
| FaxNumber: | 8017828412 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 N HARRISVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844042580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013991818 | ||||||||
| FaxNumber: | 8017828412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | PALAU | ||||||||
| AuthorizedOfficialFirstName: | M SHAWN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8013991818 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 2084A0401X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1952432635 | 05 | UT | MEDICAID |