Provider Demographics
NPI:1114218625
Name:MENTAL HEALTH KOKUA
Entity Type:Organization
Organization Name:MENTAL HEALTH KOKUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ED
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-737-2523
Mailing Address - Street 1:1221 KAPIOLANI BLVD STE 345
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3510
Mailing Address - Country:US
Mailing Address - Phone:808-737-2523
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD STE 345
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3510
Practice Address - Country:US
Practice Address - Phone:808-737-2523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1033258348OtherHAWAII DEPARTMENT OF HEALTH, ADULT MENTAL HEALTH DIVISION