Healthcare Provider Details

I. General information

NPI: 1700796737
Provider Name (Legal Business Name): KELLI T TE'O LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55-510 KAMEHAMEHA HWY STE 15
LAIE HI
96762-1119
US

IV. Provider business mailing address

55-660 NANILOA LOOP
LAIE HI
96762-1286
US

V. Phone/Fax

Practice location:
  • Phone: 702-249-1982
  • Fax:
Mailing address:
  • Phone: 808-590-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5554
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: