Provider Demographics
NPI:1720366545
Name:WELLS, FORREST ALDEN KAIAO (MHC, NCC)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:ALDEN KAIAO
Last Name:WELLS
Suffix:
Gender:M
Credentials:MHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-024 HIHIMANU ST
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1606
Mailing Address - Country:US
Mailing Address - Phone:808-222-3588
Mailing Address - Fax:808-262-2747
Practice Address - Street 1:40 AULIKE ST
Practice Address - Street 2:SUIT 411
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2758
Practice Address - Country:US
Practice Address - Phone:808-222-3588
Practice Address - Fax:808-262-2747
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC 263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health