Provider Demographics
NPI:1356222681
Name:CHRISTENSEN, ISIAH THOMAS
Entity type:Individual
Prefix:
First Name:ISIAH
Middle Name:THOMAS
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HOAKA RD
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3623
Mailing Address - Country:US
Mailing Address - Phone:808-315-9050
Mailing Address - Fax:
Practice Address - Street 1:69 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7509
Practice Address - Country:US
Practice Address - Phone:808-935-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-25-466595106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician