Healthcare Provider Details

I. General information

NPI: 1598277329
Provider Name (Legal Business Name): KAI MCBRIDE LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 7199 MAMALAHOA HIGHWAY APT C121
HOLUALOA HI
96725
US

IV. Provider business mailing address

79 7199 MAMALAHOA HIGHWAY APT C121
HOLUALOA HI
96725
US

V. Phone/Fax

Practice location:
  • Phone: 916-835-8836
  • Fax:
Mailing address:
  • Phone: 916-835-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number473
License Number StateHI

VIII. Authorized Official

Name: KAI PATRICK MCBRIDE
Title or Position: OWNER
Credential: LMFT
Phone: 916-835-8836