Healthcare Provider Details

I. General information

NPI: 1649977851
Provider Name (Legal Business Name): JUYEON SUH A-LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 N KAINALU DR
KAILUA HI
96734-2331
US

IV. Provider business mailing address

224 KAMEHAMEHA AVE STE 201
HILO HI
96720-2878
US

V. Phone/Fax

Practice location:
  • Phone: 808-825-4214
  • Fax:
Mailing address:
  • Phone: 808-825-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCP-52
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: