Healthcare Provider Details

I. General information

NPI: 1306937818
Provider Name (Legal Business Name): CHERYL LEE GAEBEL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1231 OPELO RD KALA COTTAGE #4
KAMUELA HI
96743-8376
US

IV. Provider business mailing address

PO BOX 6477
KAMUELA HI
96743-6477
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-9668
  • Fax: 808-885-8549
Mailing address:
  • Phone: 808-885-9668
  • Fax: 808-885-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY-402
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: