Provider Demographics
NPI:1194183723
Name:KAIAO OLA INTEGRATIVE HEALING, LLC
Entity Type:Organization
Organization Name:KAIAO OLA INTEGRATIVE HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MADELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO-KIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-937-9699
Mailing Address - Street 1:PO BOX 2099
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-2099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65-1298B KAWAIHAE RD
Practice Address - Street 2:SUITE 21
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7342
Practice Address - Country:US
Practice Address - Phone:808-937-9699
Practice Address - Fax:808-885-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT - 262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty