MEDICARE: ALOHA OCEAN CLINIC, LLC

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	103TC1900X	Counseling Psychologist	1388	HI

General Provider Information

NPI Number	:	1962832592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALOHA OCEAN CLINIC, LLC

Provider Business Mailing Address
First Line	:	1979 AAMAKA PL
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-1302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1001 KAIMALIE ST STE 201B
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6250
Country	:	US
Telephone Number	:	808-230-5224
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SIMONE OVERMAN-STARKMAN
Credential	:	PSYD
Telephone Number	:	808-230-5224

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	10/22/2015

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