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General NPI Number Information
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NPI Number | 1215359989
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Entity Type | Organization
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Legal Business Name | FIVE MOUNTAINS HAWAII, INC
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 64-1035 MAMALAHO HWY STE F
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City | KAMUELA
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State | HI
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Zip | 96743-8440
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Country | US
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Telephone | 808-885-5900
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Fax | 808-885-6900
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Provider Business Mailing Address
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Address Line | PO BOX 818
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City | KAMUELA
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State | HI
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Zip | 96743-0818
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Country | US
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Telephone | 808-885-5900
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Fax | 808-885-6900
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CLAREN KUULEI KEALOHA-BEAUDET
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Credential | PSYD
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Telephone | 808-885-5900
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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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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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