Provider Demographics
NPI:1578008520
Name:TEMPLE VALLEY MINDFUL WELLNESS LLC
Entity Type:Organization
Organization Name:TEMPLE VALLEY MINDFUL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-780-7603
Mailing Address - Street 1:47-610 HUI ULILI ST APT A
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4642
Mailing Address - Country:US
Mailing Address - Phone:808-780-7603
Mailing Address - Fax:888-974-1502
Practice Address - Street 1:1005 KEOLU DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3873
Practice Address - Country:US
Practice Address - Phone:808-780-7603
Practice Address - Fax:888-974-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 40281041C0700X
HI329 LMFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty