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General NPI Number Information
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NPI Number | 1720741473
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Entity Type | Organization
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Legal Business Name | KAUHALE HEALING LLC
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 75-5706 HANAMA PL STE 110
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City | KAILUA KONA
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State | HI
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Zip | 96740-1713
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Country | US
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Telephone | 808-480-1247
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4920
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City | KAILUA KONA
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State | HI
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Zip | 96745-4920
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Country | US
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Telephone | 808-480-1247
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | DAMIEN YOUNG
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Credential | LMFT
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Telephone | 808-480-1247
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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 |
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License Number State |
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