Provider Demographics
NPI:1497464762
Name:SHULL, JOLENE D (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:D
Last Name:SHULL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-0418
Mailing Address - Country:US
Mailing Address - Phone:760-221-9489
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE STE A216
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1869
Practice Address - Country:US
Practice Address - Phone:760-221-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist