=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730773466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2021
-----------------------------------------------------
Last Update Date | 02/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-1221 KA UKA BLVD STE B202
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-226-9442
-----------------------------------------------------
Fax | 808-671-0222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94-1221 KA UKA BLVD SUITE 108 PMB 343
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-226-9442
-----------------------------------------------------
Fax | 808-671-0222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARRIAGE AND FAMILY THERAPIST
-----------------------------------------------------
Name | EDWINA L REYES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-375-7712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------