=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861119919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOOKMARK COUNSELING AND CONSULTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2022
-----------------------------------------------------
Last Update Date | 10/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1308 KUUNA ST
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-3662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-334-1248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 457
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-0457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATHANIEL SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-334-1248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------