Healthcare Provider Details

I. General information

NPI: 1376966804
Provider Name (Legal Business Name): PAUL JOSEPH SULLA III MA, MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: P. JOSEPH SULLA III MA, MFT

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HINANO ST
HILO HI
96720-4427
US

IV. Provider business mailing address

PO BOX 1514
HONOKAA HI
96727-1514
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-1935
  • Fax: 808-969-3276
Mailing address:
  • Phone: 808-937-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: