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General NPI Number Information
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NPI Number | 1114105848
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Entity Type | Organization
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Legal Business Name | PSYCHE, INC.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 3809 SIERRA DR
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City | HONOLULU
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State | HI
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Zip | 96816-3819
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Country | US
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Telephone | 808-737-3737
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Fax | 808-737-3737
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Provider Business Mailing Address
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Address Line | 3809 SIERRA DR
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City | HONOLULU
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State | HI
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Zip | 96816-3819
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Country | US
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Telephone | 808-737-3737
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Fax | 808-737-3737
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Authorized Official
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Title or Position | OWNER
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Name | DR. GAIL DENISE INGRAM
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Credential | M.D.
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Telephone | 808-737-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MD7761
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License Number State | HI
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