Healthcare Provider Details

I. General information

NPI: 1780635383
Provider Name (Legal Business Name): TERESA ANN LATHROP M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DR
AIEA HI
96701-3925
US

IV. Provider business mailing address

99-128 AIEA HEIGHTS DR
AIEA HI
96701-3940
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-0933
  • Fax: 808-955-0933
Mailing address:
  • Phone: 808-955-0933
  • Fax: 808-955-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: