Provider Demographics
NPI:1154820538
Name:KALA & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KALA & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LMHC
Authorized Official - Prefix:MS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELIIHOOMALU
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CRC, LMHC
Authorized Official - Phone:808-966-5997
Mailing Address - Street 1:PO BOX 1493
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-1493
Mailing Address - Country:US
Mailing Address - Phone:808-966-5997
Mailing Address - Fax:808-966-5998
Practice Address - Street 1:15-3039 PAHOA VILLAGE RD.
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-966-5997
Practice Address - Fax:808-966-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-87101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000348599Medicaid