Provider Demographics
NPI:1083716765
Name:LOO, CHALSA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHALSA
Middle Name:M
Last Name:LOO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 BISHOP ST STE 1502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2817
Mailing Address - Country:US
Mailing Address - Phone:808-526-2008
Mailing Address - Fax:808-585-8002
Practice Address - Street 1:1164 BISHOP ST STE 1502
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2817
Practice Address - Country:US
Practice Address - Phone:808-526-2008
Practice Address - Fax:808-585-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07763701Medicaid
HIS21772Medicare UPIN
HI07763701Medicaid