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General NPI Number Information
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NPI Number | 1588983324
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Entity Type | Organization
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Legal Business Name | PACIFIC RIM PLAY THERAPY LLC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 12/11/2010
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Provider Practice Location Address
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Address Line | 49 S HOTEL ST SUITE 201
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City | HONOLULU
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State | HI
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Zip | 96813-3108
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Country | US
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Telephone | 808-722-7045
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 235060
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City | HONOLULU
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State | HI
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Zip | 96823-3500
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Country | US
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Telephone | 808-722-7045
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ELIZABETH M KONG
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Credential | LMFT
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Telephone | 808-722-7045
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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 | MFT 238
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License Number State | HI
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