Provider Demographics
NPI:1609517317
Name:IMOSE, KELSEA ALOHILANI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELSEA
Middle Name:ALOHILANI
Last Name:IMOSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-1283
Mailing Address - Country:US
Mailing Address - Phone:808-922-4787
Mailing Address - Fax:
Practice Address - Street 1:277 OHUA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-6612
Practice Address - Country:US
Practice Address - Phone:808-922-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical