Provider Demographics
NPI:1063021145
Name:COMMON CHORD PSYCHOLOGY SERVICES, INC
Entity Type:Organization
Organization Name:COMMON CHORD PSYCHOLOGY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SPRAGUE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-639-1404
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-0044
Mailing Address - Country:US
Mailing Address - Phone:808-639-1404
Mailing Address - Fax:
Practice Address - Street 1:2325 LILIUOKALANI ST
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5304
Practice Address - Country:US
Practice Address - Phone:808-639-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty