Healthcare Provider Details

I. General information

NPI: 1619257839
Provider Name (Legal Business Name): CYNTHIA C KOZIOLAS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S WAKEA AVE STE 208
KAHULUI HI
96732-1385
US

IV. Provider business mailing address

PO BOX 2206
KIHEI HI
96753-2206
US

V. Phone/Fax

Practice location:
  • Phone: 808-283-4251
  • Fax:
Mailing address:
  • Phone: 808-283-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number292
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: