Provider Demographics
NPI:1790409662
Name:PUCKETT, NINA HOOMAIKAIANA (LMHC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:HOOMAIKAIANA
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1187 HOKUULA RD
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8300
Mailing Address - Country:US
Mailing Address - Phone:808-557-3114
Mailing Address - Fax:
Practice Address - Street 1:65-1187 HOKUULA RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8300
Practice Address - Country:US
Practice Address - Phone:808-557-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-897-0101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health