Provider Demographics
NPI:1467822700
Name:KORATHU-LARSON, PRIYA (BS)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:KORATHU-LARSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 DOLE ST
Mailing Address - Street 2:SAKAMAKI C 400
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2309
Mailing Address - Country:US
Mailing Address - Phone:808-956-9559
Mailing Address - Fax:808-956-2218
Practice Address - Street 1:2500 DOLE ST
Practice Address - Street 2:101 KRAUSS HALL
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2349
Practice Address - Country:US
Practice Address - Phone:808-956-9559
Practice Address - Fax:808-956-2218
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor