Healthcare Provider Details

I. General information

NPI: 1043190754
Provider Name (Legal Business Name): HALEAKALA COUNSELING COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 IHE PL UNIT B
KULA HI
96790-8903
US

IV. Provider business mailing address

100 IHE PL UNIT B
KULA HI
96790-8903
US

V. Phone/Fax

Practice location:
  • Phone: 808-724-1634
  • Fax:
Mailing address:
  • Phone: 808-724-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELSEY S. MANGLALLAN
Title or Position: OWNER/MEMBER
Credential: LCSW
Phone: 808-724-1634