Healthcare Provider Details

I. General information

NPI: 1194498329
Provider Name (Legal Business Name): PULAMA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 07/24/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 11TH AVE STE 301
HONOLULU HI
96816-2443
US

IV. Provider business mailing address

3495 E MANOA RD
HONOLULU HI
96822-1332
US

V. Phone/Fax

Practice location:
  • Phone: 808-773-4560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOY NYT WINQUIST
Title or Position: OWNER
Credential: LCSW
Phone: 808-392-3340