Provider Demographics
NPI:1497208672
Name:NAKANO, KALEO KEALOHANUI
Entity Type:Individual
Prefix:
First Name:KALEO
Middle Name:KEALOHANUI
Last Name:NAKANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6512
Mailing Address - Country:US
Mailing Address - Phone:808-895-1365
Mailing Address - Fax:
Practice Address - Street 1:1410 N 19TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6512
Practice Address - Country:US
Practice Address - Phone:808-895-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor