Provider Demographics
NPI:1184383820
Name:MAUI MINDFULNESS CENTER, LLC
Entity type:Organization
Organization Name:MAUI MINDFULNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:808-269-5996
Mailing Address - Street 1:3483 MALINA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9246
Mailing Address - Country:US
Mailing Address - Phone:808-269-5996
Mailing Address - Fax:
Practice Address - Street 1:3483 MALINA PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-9246
Practice Address - Country:US
Practice Address - Phone:808-269-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI824955Medicaid