Healthcare Provider Details

I. General information

NPI: 1023742970
Provider Name (Legal Business Name): MAI THERAPIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KAHELU AVE STE 232
MILILANI HI
96789-3962
US

IV. Provider business mailing address

PO BOX 2411
EWA BEACH HI
96706-0411
US

V. Phone/Fax

Practice location:
  • Phone: 808-940-1437
  • Fax:
Mailing address:
  • Phone: 808-940-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAILE KIMURA
Title or Position: THERAPIST
Credential:
Phone: 808-940-1437