1073656021 NPI number — WINDS OF CHANGE PSYCHOLOGICAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073656021 NPI number — WINDS OF CHANGE PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDS OF CHANGE PSYCHOLOGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073656021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 690107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAKAWELI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96769-0107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-332-8370
Provider Business Mailing Address Fax Number:
808-332-6352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2-2514 KAUMUALII HWY
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
KALAHEO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96741-8303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-332-8370
Provider Business Practice Location Address Fax Number:
808-332-6352
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
808-332-8370

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  971 , 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)





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