Provider Demographics
NPI:1043745532
Name:ELEMENTAL GUIDANCE LLC
Entity Type:Organization
Organization Name:ELEMENTAL GUIDANCE LLC
Other - Org Name:ELEMENTAL COUPLE AND FAMILY THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VISHWANI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAM-SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:612-644-0737
Mailing Address - Street 1:260 KAMEHAMEHA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2859
Mailing Address - Country:US
Mailing Address - Phone:612-644-0737
Mailing Address - Fax:
Practice Address - Street 1:260 KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2859
Practice Address - Country:US
Practice Address - Phone:612-644-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-438106H00000X
HIMFT-397261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty