Provider Demographics
NPI:1194367979
Name:NORTH SHORE COLLABORATIVE THERAPY
Entity Type:Organization
Organization Name:NORTH SHORE COLLABORATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-457-1311
Mailing Address - Street 1:66-892 WANINI ST
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9758
Mailing Address - Country:US
Mailing Address - Phone:808-457-1311
Mailing Address - Fax:808-664-3247
Practice Address - Street 1:66-892 WANINI ST
Practice Address - Street 2:
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791-9758
Practice Address - Country:US
Practice Address - Phone:808-457-1311
Practice Address - Fax:808-457-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty