Healthcare Provider Details

I. General information

NPI: 1124666276
Provider Name (Legal Business Name): CENTER FOR HEALING & TRANSFORMATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 ONIONI ST
KAILUA HI
96734-3760
US

IV. Provider business mailing address

1447 ONIONI ST
KAILUA HI
96734-3760
US

V. Phone/Fax

Practice location:
  • Phone: 808-451-3960
  • Fax: 808-451-3961
Mailing address:
  • Phone: 808-451-3960
  • Fax: 808-451-3961

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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JEREMY KALAN
Title or Position: CEO
Credential: LMHC
Phone: 808-451-3960