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General NPI Number Information
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NPI Number | 1922408020
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Entity Type | Organization
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Legal Business Name | KOKUA SUPPORT SERVICES
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 1803 N KING ST
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City | HONOLULU
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State | HI
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Zip | 96819-3451
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Country | US
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Telephone | 808-847-4227
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Fax | 808-842-0044
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Provider Business Mailing Address
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Address Line | PO BOX 17870
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City | HONOLULU
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State | HI
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Zip | 96817-0870
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Country | US
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Telephone | 808-847-4227
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRISTYN HAXTON
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Credential | MSCP,CSAC, SAP
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Telephone | 808-847-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10694948
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License Number State | HI
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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 | 10694948
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 10694948
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License Number State | HI
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10694948
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License Number State | HI
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 10694948
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License Number State | HI
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 10694948
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License Number State | HI
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Taxonomy #7
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 10694948
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License Number State | HI
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Taxonomy #8
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 10694948
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License Number State | HI
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