Organization
MARK D BREITHAUPT PHD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DOUGLAS BREITHAUPT PHD (LICENSED CLINICAL PSYCHOLOGIST)
(808) 205-8403
Entity
Organization
Contact information
Practice address
2200 MAIN ST, WAILUKU, HI 96793-1681
(808) 205-8403
Mailing address
PO BOX 2632, WAILUKU, HI 96793-7632
(808) 205-8403
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY499
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03451701
—
HI
01
—
HMSA
HMSA
HI
Enumeration date
10/06/2010
Last updated
05/19/2025
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