Provider Demographics
NPI:1053851170
Name:KOHATSU, BRIAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:KOHATSU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:ANAHOLA
Mailing Address - State:HI
Mailing Address - Zip Code:96703-0296
Mailing Address - Country:US
Mailing Address - Phone:808-436-5490
Mailing Address - Fax:
Practice Address - Street 1:4156 RICE ST
Practice Address - Street 2:APT 215
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1401
Practice Address - Country:US
Practice Address - Phone:808-436-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI42091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical