Provider Demographics
NPI:1013408509
Name:TAEZA-VINCENT, KASSEL TUZON
Entity Type:Individual
Prefix:
First Name:KASSEL
Middle Name:TUZON
Last Name:TAEZA-VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HOOLA HOU ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-5714
Mailing Address - Country:US
Mailing Address - Phone:808-344-8236
Mailing Address - Fax:
Practice Address - Street 1:23 HOOLA HOU ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-5714
Practice Address - Country:US
Practice Address - Phone:808-344-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist