Healthcare Provider Details

I. General information

NPI: 1063260628
Provider Name (Legal Business Name): KUOKOA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 07/11/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-2832 MAHIMAHI ST
PAHOA HI
96778-9123
US

IV. Provider business mailing address

PO BOX 1197
KAILUA KONA HI
96745-1197
US

V. Phone/Fax

Practice location:
  • Phone: 719-502-1366
  • Fax:
Mailing address:
  • Phone: 719-502-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. CLARENCE AUSTIN CHURCH III
Title or Position: OWNER
Credential: LMHC
Phone: 719-502-1366