Healthcare Provider Details

I. General information

NPI: 1962882340
Provider Name (Legal Business Name): PSYCHOLOGY HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 NUUANU AVE # LL2 VALDEN MEDICAL
HONOLULU HI
96817-5190
US

IV. Provider business mailing address

928 NUUANU AVE # LLS2 VALDEN MEDICAL
HONOLULU HI
96817-5190
US

V. Phone/Fax

Practice location:
  • Phone: 808-538-2800
  • Fax: 808-536-2024
Mailing address:
  • Phone: 808-538-2800
  • Fax: 808-536-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-1418
License Number StateHI

VIII. Authorized Official

Name: KELLY HOOLANI
Title or Position: OFFICE MANAGER/VALDEN MEDICAL
Credential:
Phone: 808-538-2800