MEDICARE: LDS FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	870489254	HI

General Provider Information

NPI Number	:	1659586725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	1500 S BERETANIA ST
Second Line	:	SUITE 402
City	:	HONOLULU
State	:	HI
Zip	:	96826-1932
Country	:	US
Telephone Number	:	808-945-3690
Fax Number	:	808-945-2811

Provider Business Practice Location Address
First Line	:	1500 S BERETANIA ST
Second Line	:	SUITE 402
City	:	HONOLULU
State	:	HI
Zip	:	96826-1932
Country	:	US
Telephone Number	:	808-945-3690
Fax Number	:	808-945-2811

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	MR. ALIFELETI MALUPO
Credential	:	MED
Telephone Number	:	808-945-3690

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	06/04/2008

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1962736959 — DR. BARBARA D LEE PSY.D.
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1609211770 — ANDRE P HIPPOLITE LCSW
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Directions to “LDS FAMILY SERVICES ” Practice Location

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