Provider Demographics
NPI:1558927194
Name:TEAM CARE CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:TEAM CARE CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:AKIRA
Authorized Official - Last Name:JICHAKU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-763-8700
Mailing Address - Street 1:58-129 WEHIWA WAY
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9757
Mailing Address - Country:US
Mailing Address - Phone:808-763-8700
Mailing Address - Fax:
Practice Address - Street 1:66-434 KAMEHAMEHA HWY STE B
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712
Practice Address - Country:US
Practice Address - Phone:808-763-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health