Provider Demographics
NPI:1467773846
Name:GOMES, AMBER K (MFT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:K
Last Name:GOMES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1035 AMAAMA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3506
Mailing Address - Country:US
Mailing Address - Phone:808-781-8298
Mailing Address - Fax:
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-781-8298
Practice Address - Fax:844-364-0160
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist