Provider Demographics
NPI:1255506465
Name:IKEMOTO, KALI (LMFT)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:IKEMOTO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-112 LELEUA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2123
Mailing Address - Country:US
Mailing Address - Phone:808-292-9882
Mailing Address - Fax:
Practice Address - Street 1:45-112 LELEUA PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2123
Practice Address - Country:US
Practice Address - Phone:808-292-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI504106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty