Healthcare Provider Details

I. General information

NPI: 1558018168
Provider Name (Legal Business Name): TARYN LEIGH CHURCH MA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1485 LOKE RD
KEAAU HI
96749-5026
US

IV. Provider business mailing address

PO BOX 1197
KAILUA KONA HI
96745-1197
US

V. Phone/Fax

Practice location:
  • Phone: 719-200-2905
  • Fax:
Mailing address:
  • Phone: 719-200-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC973
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: