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General NPI Number Information
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NPI Number | 1205459492
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Entity Type | Organization
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Legal Business Name | OUTCOMES CLINIC LLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1314 S KING ST STE 1255
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City | HONOLULU
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State | HI
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Zip | 96814-1947
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Country | US
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Telephone | 808-798-8781
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Fax | 877-308-8745
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Provider Business Mailing Address
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Address Line | 1314 S KING ST STE 1255
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City | HONOLULU
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State | HI
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Zip | 96814-1947
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Country | US
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Telephone | 808-744-2002
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Fax | 737-221-5808
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Authorized Official
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Title or Position | SOLE OWNER
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Name | TRISA MARIE DANZ
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Credential | MD
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Telephone | 808-798-8781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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