MEDICARE: VITALITY THERAPEUTICS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700585049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY THERAPEUTICS

Provider Business Mailing Address
First Line	:	PO BOX 873
Second Line	:
City	:	KAILUA KONA
State	:	HI
Zip	:	96745-0873
Country	:	US
Telephone Number	:	406-225-7797
Fax Number	:

Provider Business Practice Location Address
First Line	:	75-971 HENRY ST BLDG 6
Second Line	:
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-3673
Country	:	US
Telephone Number	:	406-225-7797
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANIELLE AMALIA OSTI CHENOWETH
Credential	:	LCPC
Telephone Number	:	406-225-7797

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	12/09/2025

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