Provider Demographics
NPI:1518552066
Name:NAKANISHI, AMY (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NAKANISHI
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 1:94-1124 MOPUA LOOP # F2
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4119
Mailing Address - Country:US
Mailing Address - Phone:808-753-3374
Mailing Address - Fax:
Practice Address - Street 1:1822 KEEAUMOKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3001
Practice Address - Country:US
Practice Address - Phone:808-753-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist