Provider Demographics
NPI:1578842084
Name:HORIUCHI, LEISSA (PSYCHOLOGY)
Entity Type:Individual
Prefix:MISS
First Name:LEISSA
Middle Name:
Last Name:HORIUCHI
Suffix:
Gender:F
Credentials:PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 KEEAUMOKU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3001
Mailing Address - Country:US
Mailing Address - Phone:808-527-4948
Mailing Address - Fax:808-527-4949
Practice Address - Street 1:1822 KEEAUMOKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3001
Practice Address - Country:US
Practice Address - Phone:808-527-4948
Practice Address - Fax:808-527-4949
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1316141054OtherCHILD CARE ORGANIZATION