Provider Demographics
NPI:1437624756
Name:CLINICAL PSYCHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:CLINICAL PSYCHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEDWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-294-0495
Mailing Address - Street 1:94-229 WAIPAHU DEPOT ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3034
Mailing Address - Country:US
Mailing Address - Phone:808-294-0495
Mailing Address - Fax:
Practice Address - Street 1:91-3575 KAULUAKOKO ST
Practice Address - Street 2:1108
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5856
Practice Address - Country:US
Practice Address - Phone:808-294-0495
Practice Address - Fax:808-439-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-13
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty