Provider Demographics
NPI:1760613459
Name:MOANA, KELEN C
Entity Type:Individual
Prefix:
First Name:KELEN
Middle Name:C
Last Name:MOANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-0325
Mailing Address - Country:US
Mailing Address - Phone:808-554-1163
Mailing Address - Fax:
Practice Address - Street 1:94-210 PUPUKAHI ST STE 207
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2649
Practice Address - Country:US
Practice Address - Phone:808-554-1163
Practice Address - Fax:808-681-1486
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC - 330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor