Provider Demographics
NPI:1679029755
Name:KOOLAU COUNSELING LLC
Entity Type:Organization
Organization Name:KOOLAU COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PSYCHOLOGIST / MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:G
Authorized Official - Last Name:ORR
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-780-6925
Mailing Address - Street 1:55-060 NAUPAKA ST
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1127
Mailing Address - Country:US
Mailing Address - Phone:808-780-6925
Mailing Address - Fax:408-757-0998
Practice Address - Street 1:55-510 KAMEHAMEHA HWY STE 14
Practice Address - Street 2:
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1197
Practice Address - Country:US
Practice Address - Phone:808-293-5555
Practice Address - Fax:408-457-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1048251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1417107939OtherINDIVIDUAL NPI