Provider Demographics
NPI:1093469553
Name:JENNY EBESUTANI PSYD LLC
Entity Type:Organization
Organization Name:JENNY EBESUTANI PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBESUTANI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-304-1565
Mailing Address - Street 1:PO BOX 235665
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3511
Mailing Address - Country:US
Mailing Address - Phone:808-304-1565
Mailing Address - Fax:
Practice Address - Street 1:1100 WARD AVE STE 665
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1619
Practice Address - Country:US
Practice Address - Phone:808-304-1565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)