Provider Demographics
NPI:1104376482
Name:INTEGRATIVE THERAPY SERVICES
Entity Type:Organization
Organization Name:INTEGRATIVE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-387-2048
Mailing Address - Street 1:3388 SALT LAKE BLVD
Mailing Address - Street 2:207
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2120
Mailing Address - Country:US
Mailing Address - Phone:808-387-2048
Mailing Address - Fax:
Practice Address - Street 1:3388 SALT LAKE BLVD
Practice Address - Street 2:207
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-2120
Practice Address - Country:US
Practice Address - Phone:808-387-2048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMFT-488251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health