Provider Demographics
NPI:1568690840
Name:KU ALOHA OLA MAU
Entity Type:Organization
Organization Name:KU ALOHA OLA MAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-538-0704
Mailing Address - Street 1:1130 N NIMITZ HWY
Mailing Address - Street 2:C302
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4579
Mailing Address - Country:US
Mailing Address - Phone:808-538-0704
Mailing Address - Fax:808-538-0474
Practice Address - Street 1:15-1926 PUAKALO (30TH) AVE.
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-982-9555
Practice Address - Fax:808-982-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty