Healthcare Provider Details

I. General information

NPI: 1922357375
Provider Name (Legal Business Name): PSYCHIATRIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 NUUANU AVE SUITE LL2
HONOLULU HI
96817-5190
US

IV. Provider business mailing address

PO BOX 37862
HONOLULU HI
96837-0862
US

V. Phone/Fax

Practice location:
  • Phone: 808-538-2800
  • Fax: 808-536-2024
Mailing address:
  • Phone: 808-664-1104
  • Fax: 866-592-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 13434
License Number StateHI

VIII. Authorized Official

Name: LILI KELLY
Title or Position: OWNER
Credential: MD
Phone: 808-664-1104