Provider Demographics
NPI:1073096004
Name:INNER ABUNDANCE THERAPY LLC
Entity Type:Organization
Organization Name:INNER ABUNDANCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE &FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KASSEL
Authorized Official - Middle Name:TUZON
Authorized Official - Last Name:TAEZA-VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-344-8236
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty