Provider Demographics
NPI:1285854646
Name:NAHM-MIJO, TRINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRINA
Middle Name:
Last Name:NAHM-MIJO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760-0304
Mailing Address - Country:US
Mailing Address - Phone:808-966-7154
Mailing Address - Fax:808-974-7757
Practice Address - Street 1:17-4205 13 MILE ROAD
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760
Practice Address - Country:US
Practice Address - Phone:808-966-7154
Practice Address - Fax:808-974-7757
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health