Provider Demographics
NPI:1790019073
Name:THRELFALL, JOHN H (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:THRELFALL
Suffix:
Gender:M
Credentials:MA, MFT
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 757
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-0757
Mailing Address - Country:US
Mailing Address - Phone:808-967-7613
Mailing Address - Fax:
Practice Address - Street 1:56 WAIANUENUE AVE
Practice Address - Street 2:214
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2474
Practice Address - Country:US
Practice Address - Phone:808-967-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist