Healthcare Provider Details

I. General information

NPI: 1225412711
Provider Name (Legal Business Name): JULIAN LEIGH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 GREEN ST
HONOLULU HI
96813-2119
US

IV. Provider business mailing address

710 GREEN ST
HONOLULU HI
96813-2119
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-8188
  • Fax: 808-356-3590
Mailing address:
  • Phone: 808-523-8188
  • Fax: 808-356-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: