1205086626 NPI number — MRS. TERILYN Y. KELIINOI LCSW

Table of content: MRS. TERILYN Y. KELIINOI LCSW (NPI 1205086626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205086626 NPI number — MRS. TERILYN Y. KELIINOI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELIINOI
Provider First Name:
TERILYN
Provider Middle Name:
Y.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
TERILYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205086626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 N. KUAKINI STREET
Provider Second Line Business Mailing Address:
SUITE #308
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-440-6852
Provider Business Mailing Address Fax Number:
808-440-6878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 N. KUAKINI STREET
Provider Second Line Business Practice Location Address:
SUITE #308
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-440-6852
Provider Business Practice Location Address Fax Number:
808-440-6878
Provider Enumeration Date:
09/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1720 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 3643 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW3643 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3643 . This is a "STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".