Provider Demographics
NPI:1497096044
Name:BODDEN, TRYSHA LEINANI MISA (MA)
Entity Type:Individual
Prefix:MRS
First Name:TRYSHA
Middle Name:LEINANI MISA
Last Name:BODDEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2032 KAIOLI ST APT 6001
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 N NIMITZ HWY RM A203
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5785
Practice Address - Country:US
Practice Address - Phone:808-294-5810
Practice Address - Fax:808-441-7744
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist