1154861573 NPI number — MAUNA KEA SKY COUNSELING LLC

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 1154861573 NPI number — MAUNA KEA SKY COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAUNA KEA SKY COUNSELING LLC
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:
1154861573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOKAA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96727-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-937-7323
Provider Business Mailing Address Fax Number:
808-933-3601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64-1040 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-937-7323
Provider Business Practice Location Address Fax Number:
808-933-3601
Provider Enumeration Date:
03/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SULLA
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MANAGER, THERAPIST
Authorized Official Telephone Number:
808-937-7323

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MFT 423 , 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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