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General NPI Number Information
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NPI Number | 1023632965
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Entity Type | Organization
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Legal Business Name | LIVE FULLY COUNSELING LLC
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Dates
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Enumeration Date | 06/06/2020
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Last Update Date | 10/18/2020
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Provider Practice Location Address
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Address Line | 1164 BISHOP ST STE 929
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone | 808-977-6210
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 BISHOP ST STE 929
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JESSE HUTCHISON
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Credential | PHD
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Telephone | 808-977-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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