Provider Demographics
NPI:1568704351
Name:RAM-SOUZA, VISHWANI SHIRVANA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:VISHWANI
Middle Name:SHIRVANA
Last Name:RAM-SOUZA
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 1:54 KAIKUONO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1730
Mailing Address - Country:US
Mailing Address - Phone:612-644-0737
Mailing Address - Fax:
Practice Address - Street 1:54 KAIKUONO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1730
Practice Address - Country:US
Practice Address - Phone:612-644-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI438106H00000X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health