Healthcare Provider Details

I. General information

NPI: 1164003489
Provider Name (Legal Business Name): TRUESELF THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-1629 SUITE C1 KUHIO HWY
KAPAA HI
96746-9674
US

IV. Provider business mailing address

PO BOX 131
ANAHOLA HI
96703-0131
US

V. Phone/Fax

Practice location:
  • Phone: 808-400-0047
  • Fax:
Mailing address:
  • Phone: 508-314-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MEGAN SMITH
Title or Position: OWNER/OPERATOR
Credential:
Phone: 808-400-0047