Healthcare Provider Details

I. General information

NPI: 1588473086
Provider Name (Legal Business Name): CHELLINA ASHLEY M OKUMURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-084 KAMEHAMEHA HWY STE 304
AIEA HI
96701-5124
US

IV. Provider business mailing address

87-531 MANUU ST
WAIANAE HI
96792-3238
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-9648
  • Fax: 833-450-0919
Mailing address:
  • Phone: 808-722-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-945-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: