Provider Demographics
NPI:1558802017
Name:LEAP OF FAITH COUNSELING LLC
Entity Type:Organization
Organization Name:LEAP OF FAITH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-635-3464
Mailing Address - Street 1:2637 KUILEI ST APT A104
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3288
Mailing Address - Country:US
Mailing Address - Phone:808-635-3464
Mailing Address - Fax:
Practice Address - Street 1:2637 KUILEI ST APT A104
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3288
Practice Address - Country:US
Practice Address - Phone:808-635-3464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI393101YM0800X
HI491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty