Healthcare Provider Details

I. General information

NPI: 1902300783
Provider Name (Legal Business Name): ELENA FOSNESS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 KAMEHAMEHA AVE # 201
HILO HI
96720-2860
US

IV. Provider business mailing address

PO BOX 492952
KEAAU HI
96749-2952
US

V. Phone/Fax

Practice location:
  • Phone: 952-856-3932
  • Fax:
Mailing address:
  • Phone: 952-856-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3556
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-888
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2050-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: