Individual
PETRA URSULA WIESENBAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
15-2903 PAHOA VILLAGE ROAD, PAHOA, HI 96778
(808) 333-4862
Mailing address
P.O. BOX 922, PAHOA, HI 96778-0922
(808) 333-4862
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
748
HI
Other
Enumeration date
12/31/2021
Last updated
12/31/2021
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