Healthcare Provider Details

I. General information

NPI: 1497930655
Provider Name (Legal Business Name): HAWAII PSYCHOLOGICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KAMOKILA BLVD SUITE 262
KAPOLEI HI
96707-2014
US

IV. Provider business mailing address

1001 KAMOKILA BLVD SUITE 262
KAPOLEI HI
96707-2014
US

V. Phone/Fax

Practice location:
  • Phone: 808-484-1122
  • Fax: 808-484-1129
Mailing address:
  • Phone: 808-484-1122
  • Fax: 808-484-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDOS1489
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY809
License Number StateHI

VIII. Authorized Official

Name: DR. ROBERT E. JACKSON
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 808-294-3493