Healthcare Provider Details

I. General information

NPI: 1073446274
Provider Name (Legal Business Name): LIGHTHOUSE THERAPY OAHU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1510 KAIKOHOLA ST
EWA BEACH HI
96706-6286
US

IV. Provider business mailing address

91-1510 KAIKOHOLA ST
EWA BEACH HI
96706-6286
US

V. Phone/Fax

Practice location:
  • Phone: 978-238-6346
  • Fax:
Mailing address:
  • Phone: 978-238-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE KEKEISEN
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 978-500-4786