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General NPI Number Information
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NPI Number | 1578008520
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Entity Type | Organization
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Legal Business Name | TEMPLE VALLEY MINDFUL WELLNESS LLC
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 1005 KEOLU DR
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City | KAILUA
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State | HI
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Zip | 96734-3873
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Country | US
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Telephone | 808-780-7603
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Fax | 888-974-1502
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Provider Business Mailing Address
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Address Line | 47-610 HUI ULILI ST APT A
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City | KANEOHE
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State | HI
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Zip | 96744-4642
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Country | US
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Telephone | 808-780-7603
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Fax | 888-974-1502
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Authorized Official
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Title or Position | LCSW/THERAPIST
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Name | RACHEL ESTHER WHIPPLE
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Credential | LCSW
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Telephone | 808-780-7603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 329 LMFT
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 4028
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License Number State | HI
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