Provider Demographics
NPI:1760141816
Name:KEIKI CLUB HOUSE INC.
Entity Type:Organization
Organization Name:KEIKI CLUB HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, EDD, LMFT
Authorized Official - Phone:808-298-6555
Mailing Address - Street 1:PO BOX 510232
Mailing Address - Street 2:
Mailing Address - City:KEALIA
Mailing Address - State:HI
Mailing Address - Zip Code:96751-0232
Mailing Address - Country:US
Mailing Address - Phone:808-298-6555
Mailing Address - Fax:808-320-8057
Practice Address - Street 1:4504 KUKUI ST
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1701
Practice Address - Country:US
Practice Address - Phone:808-298-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty