Individual
MR. MARVIN OTIS ST CLAIR III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
113850 6TH, VOLCANO, HI 96785
(808) 967-8580
(808) 934-0071
Mailing address
PO BOX 575, VOLCANO, HI 96785-0575
(808) 961-5166
(808) 934-0071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3187
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000252791
HMSA PROVIDER NUMBER
HI
05
—
536336
—
HI
Enumeration date
02/14/2007
Last updated
09/24/2018
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