=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588871883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA N HEILIGENTHAL PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3-2600 KAUMUALII HWY SUITE #1300 BOX 137
-----------------------------------------------------
City | LIHUE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-343-2236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3-2600 KAUMUALII HWY SUITE #1300 BOX 137
-----------------------------------------------------
City | LIHUE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-343-2236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0999
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY0999
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------