Healthcare Provider Details

I. General information

NPI: 1003080771
Provider Name (Legal Business Name): CLAREN KUULEI KEALOHA-BEAUDET PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1035 MAMALAHOA HWY STE F
KAMUELA HI
96743-8440
US

IV. Provider business mailing address

PO BOX 818 #4
KAMUELA HI
96743-0818
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-5900
  • Fax: 808-885-6900
Mailing address:
  • Phone: 808-885-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1040
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: