Doctor Name: | GWEN L KELIIHOOMALU |
NPI Number: | 1770959207 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, CRC, LMHC |
License Number: | 87 |
Business Practice Address: | 15-2885 Pahoa Main Street Pahoa, HI - 96778 |
Business Phone Number: | 8089652233 |
Business Fax Number: | |
Mailing Address: | Po Box 1493, HILO |
State: | HI |
Postal Code: | 967211493 |
Phone Number: | 8089665997 |
Fax Number: | |
NPI Enumeration Date: | 08/19/2015 |
NPI Last Update Date: | 08/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 87 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |