Doctor Name: | JUDITH MARIE EKSTROM |
NPI Number: | 1629416581 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | 299 |
Business Practice Address: | 15-3039 Pahoa Village Rd Pahoa, HI - 967789998 |
Business Phone Number: | 8089874321 |
Business Fax Number: | |
Mailing Address: | Hc 2 Box 6410, KEAAU |
State: | HI |
Postal Code: | 967499305 |
Phone Number: | 8089874321 |
Fax Number: | |
NPI Enumeration Date: | 06/12/2013 |
NPI Last Update Date: | 06/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 299 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |