Provider Demographics
NPI:1063869543
Name:STETZ, MELBA C (PHD)
Entity type:Individual
Prefix:DR
First Name:MELBA
Middle Name:C
Last Name:STETZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 AIKAHI LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1674
Mailing Address - Country:US
Mailing Address - Phone:808-347-4626
Mailing Address - Fax:
Practice Address - Street 1:97 AIKAHI LOOP
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1674
Practice Address - Country:US
Practice Address - Phone:808-347-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist