Provider Demographics
NPI:1538317250
Name:BERGHOLZ, GEORGE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BERGHOLZ
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N NIMITZ HWY
Mailing Address - Street 2:APT 1906
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5338
Mailing Address - Country:US
Mailing Address - Phone:808-306-7708
Mailing Address - Fax:
Practice Address - Street 1:60 N NIMITZ HWY
Practice Address - Street 2:APT 1906
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5338
Practice Address - Country:US
Practice Address - Phone:808-306-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health