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General NPI Number Information
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NPI Number | 1245743160
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Entity Type | Organization
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Legal Business Name | MATTHEW BURRILL, LMHC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 1188 BISHOP ST STE 2905
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City | HONOLULU
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State | HI
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Zip | 96813-3312
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Country | US
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Telephone | 808-442-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 3RD AVE APT A
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City | HONOLULU
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State | HI
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Zip | 96816-5876
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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 | OWNER
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Name | MATTHEW BURRILL
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Credential | LMHC
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Telephone | 808-442-2469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHC437
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License Number State | HI
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