Provider Demographics
NPI:1346417367
Name:PLAY THERAPY CENTER OF HAWAII, LLC.
Entity Type:Organization
Organization Name:PLAY THERAPY CENTER OF HAWAII, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-261-0066
Mailing Address - Street 1:315 ULUNIU ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2523
Mailing Address - Country:US
Mailing Address - Phone:808-261-0066
Mailing Address - Fax:
Practice Address - Street 1:315 ULUNIU ST
Practice Address - Street 2:SUITE 207
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2523
Practice Address - Country:US
Practice Address - Phone:808-261-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI218735OtherHMSA
HI236310OtherKAISER