Healthcare Provider Details

I. General information

NPI: 1477725125
Provider Name (Legal Business Name): ULA RAINE ANDERSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 KEAWE ST STE 22
HILO HI
96720-2849
US

IV. Provider business mailing address

PO BOX 269
PAPAIKOU HI
96781-0269
US

V. Phone/Fax

Practice location:
  • Phone: 808-443-7700
  • Fax:
Mailing address:
  • Phone: 808-443-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: