MEDICARE: AKAHAI EMOTIONAL WELLNESS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106H00000X	Marriage & Family Therapist
2	101Y00000X	Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	101YP2500X	Professional Counselor
5	104100000X	Social Worker
6	1041C0700X	Clinical Social Worker
7	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1295541084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKAHAI EMOTIONAL WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11201
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96721-6201
Country	:	US
Telephone Number	:	808-720-3637
Fax Number	:	877-441-7008

Provider Business Practice Location Address
First Line	:	154 WAIANUENUE AVE UNIT 11201
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96721-2105
Country	:	US
Telephone Number	:	808-720-3637
Fax Number	:	877-441-7008

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	MR. KEVIN LEE FAUST
Credential	:	LMHC
Telephone Number	:	808-720-3637

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	12/05/2024

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