Healthcare Provider Details

I. General information

NPI: 1114252913
Provider Name (Legal Business Name): KRISTIN LOVE NEMZER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-3006 PUAKEA BAY DR, 278
HAWI HI
96719
US

IV. Provider business mailing address

PO BOX 278
HAWI HI
96719-0278
US

V. Phone/Fax

Practice location:
  • Phone: 808-640-1200
  • Fax:
Mailing address:
  • Phone: 831-345-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC42308
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT480
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: