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General NPI Number Information
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NPI Number | 1891456133
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Entity Type | Individual
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Provider Name | LYDELL TUPUONO LAWRENCE MHC
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Gender | Male
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Dates
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Enumeration Date | 01/08/2022
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 224 KAMEHAMEHA AVE # 201
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City | HILO
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State | HI
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Zip | 96720-2860
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Country | US
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Telephone | 808-825-4214
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Fax |
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Provider Business Mailing Address
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Address Line | 55-455 MOANA ST # A
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City | LAIE
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State | HI
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Zip | 96762-1123
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Country | US
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Telephone | 808-751-0774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1048
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License Number State | HI
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