Provider Demographics
NPI:1689940827
Name:HOO, AUDREY L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:L
Last Name:HOO
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 1:4348 WAIALAE AVE
Mailing Address - Street 2:#263
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5767
Mailing Address - Country:US
Mailing Address - Phone:808-782-6860
Mailing Address - Fax:
Practice Address - Street 1:4348 WAIALAE AVE
Practice Address - Street 2:#263
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5767
Practice Address - Country:US
Practice Address - Phone:808-782-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical