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General NPI Number Information
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NPI Number | 1437624756
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Entity Type | Organization
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Legal Business Name | CLINICAL PSYCHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 10/13/2018
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 91-3575 KAULUAKOKO ST 1108
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City | EWA BEACH
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State | HI
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Zip | 96706-5856
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Country | US
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Telephone | 808-294-0495
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Fax | 808-439-6869
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Provider Business Mailing Address
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Address Line | 94-229 WAIPAHU DEPOT ST STE 400
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City | WAIPAHU
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State | HI
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Zip | 96797-3034
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Country | US
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Telephone | 808-294-0495
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST / OWNER
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Name | DR. SHAWNA LYNN LEDWARD
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Credential | PSYD
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Telephone | 808-294-0495
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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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