Provider Demographics
NPI:1376055046
Name:ORCHID ISLE HAWAI'I, INC
Entity Type:Organization
Organization Name:ORCHID ISLE HAWAI'I, INC
Other - Org Name:ORCHID ISLE PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:808-333-8988
Mailing Address - Street 1:77-401 PU'UWAI ALI'I PLACE
Mailing Address - Street 2:
Mailing Address - City:KAILUA-KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:808-333-8988
Mailing Address - Fax:808-322-2448
Practice Address - Street 1:75-5995 KUAKINI HWY.
Practice Address - Street 2:STE 900
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-333-8988
Practice Address - Fax:808-464-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT154106H00000X
CAMFCC38611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI612524-01Medicaid
CA612524-01Medicaid