Healthcare Provider Details

I. General information

NPI: 1760182182
Provider Name (Legal Business Name): GOOD MOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 KAPIOLANI BLVD PH 50
HONOLULU HI
96814-3518
US

IV. Provider business mailing address

92-834 KINOHI PL APT 13
KAPOLEI HI
96707-1304
US

V. Phone/Fax

Practice location:
  • Phone: 808-266-0609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CATEKISTA
Title or Position: LCSW
Credential:
Phone: 808-266-0609