Individual
DR. MARK DOUGLAS BREITHAUPT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2200 MAIN ST STE 510, WAILUKU, HI 96793-1624
(808) 205-8403
Mailing address
PO BOX 2632, WAILUKU, HI 96793-7632
(808) 205-8403
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY 499
HI
103TC0700X
Clinical Psychologist
Primary
PSY 499
HI
106H00000X
Marriage & Family Therapist
PSY 499
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03451701
—
HI
01
—
A 3812-3
HMSA
HI
Enumeration date
03/19/2007
Last updated
05/19/2025
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