=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700585049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALITY THERAPEUTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2023
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75-971 HENRY ST BLDG 6
-----------------------------------------------------
City | KAILUA KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96740-3673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-225-7797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 873
-----------------------------------------------------
City | KAILUA KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96745-0873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-225-7797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DANIELLE AMALIA OSTI CHENOWETH
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 406-225-7797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------