| Doctor Name: | DR. TIMOTHY KEMP AMBROSE |
| NPI Number: | 1003913435 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PSY-735 |
| Business Practice Address: | 14-4034 Pahoa-kalapana Road Pahoa, HI - 96778 |
| Business Phone Number: | 8089659416 |
| Business Fax Number: | 8089651661 |
| Mailing Address: | Po Box 1476, PAHOA |
| State: | HI |
| Postal Code: | 967781476 |
| Phone Number: | 8089659416 |
| Fax Number: | 8089651661 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY-735 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |