Provider Demographics
NPI:1366820003
Name:TOM, KRISTEN KT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:KT
Last Name:TOM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:K
Other - Last Name:TAMASHIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:848 S BERETANIA ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2551
Mailing Address - Country:US
Mailing Address - Phone:808-227-2136
Mailing Address - Fax:
Practice Address - Street 1:848 S BERETANIA ST
Practice Address - Street 2:SUITE 311
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2551
Practice Address - Country:US
Practice Address - Phone:808-227-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical