MEDICARE: ALISSA GINO LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	239	HI

General Provider Information

NPI Number	:	1295063048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA GINO LMHC

Provider Business Mailing Address
First Line	:	1154 FORT STREET MALL STE 206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2712
Country	:	US
Telephone Number	:	808-375-9867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1154 FORT STREET MALL STE 206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2712
Country	:	US
Telephone Number	:	808-375-9867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	07/27/2011

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