Provider Demographics
NPI:1467963389
Name:THIRAVONG, KAWEHI CHLOE (BA)
Entity Type:Individual
Prefix:
First Name:KAWEHI
Middle Name:CHLOE
Last Name:THIRAVONG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WAIAMANU ST. SUITE 612
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5248
Mailing Address - Country:US
Mailing Address - Phone:808-791-6713
Mailing Address - Fax:808-791-6081
Practice Address - Street 1:875 WAIMANU ST SUITE 612
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5248
Practice Address - Country:US
Practice Address - Phone:808-791-6713
Practice Address - Fax:808-791-6081
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist