Provider Demographics
NPI:1326475575
Name:KIMURA, MAILE NICOLE SUEKO (LMFT, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MAILE
Middle Name:NICOLE SUEKO
Last Name:KIMURA
Suffix:
Gender:F
Credentials:LMFT, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KAHELU AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3913
Mailing Address - Country:US
Mailing Address - Phone:808-625-3000
Mailing Address - Fax:
Practice Address - Street 1:100 KAHELU AVE STE 110
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3913
Practice Address - Country:US
Practice Address - Phone:808-625-3000
Practice Address - Fax:808-625-3006
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
HI1-20-46743103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner