Individual
JASON DONALD WISDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, MED., LMFT, BCBA
Contact information
Practice address
98-501 KOAUKA LOOP APT 305, AIEA, HI 96701-4560
(360) 470-2183
Mailing address
98-501 KOAUKA LOOP APT A305, AIEA, HI 96701-5827
(360) 470-2183
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
BA-610
HI
106H00000X
Marriage & Family Therapist
Primary
MFT-805
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003128
—
HI
Enumeration date
11/09/2021
Last updated
07/26/2023
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