Provider Demographics
NPI:1659704047
Name:PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:KIKUE
Authorized Official - Last Name:GOYA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-295-2338
Mailing Address - Street 1:95-988 UKUWAI ST
Mailing Address - Street 2:#603
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6024
Mailing Address - Country:US
Mailing Address - Phone:808-295-2338
Mailing Address - Fax:808-951-9282
Practice Address - Street 1:1833 KALAKAUA AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1512
Practice Address - Country:US
Practice Address - Phone:808-927-6765
Practice Address - Fax:808-951-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07131930000633-001Medicare UPIN