Provider Demographics
NPI:1508008327
Name:THE FAMILY PSYCHOLOGIST, INC
Entity Type:Organization
Organization Name:THE FAMILY PSYCHOLOGIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CUMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-323-9510
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-1323
Mailing Address - Country:US
Mailing Address - Phone:808-323-9510
Mailing Address - Fax:808-323-9703
Practice Address - Street 1:81-6587 MAMALAHOA HIGHWAY
Practice Address - Street 2:PUALANI TERRACE, C-23
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750
Practice Address - Country:US
Practice Address - Phone:808-323-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIP SY388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1215982616Medicaid
HI1215982616Medicaid