Provider Demographics
NPI:1821242116
Name:ANUENUE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ANUENUE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/ MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COUTSOURAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:808-295-8568
Mailing Address - Street 1:92-7075 ELELE ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2312
Mailing Address - Country:US
Mailing Address - Phone:808-295-8568
Mailing Address - Fax:808-672-3605
Practice Address - Street 1:92-7075 ELELE ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2312
Practice Address - Country:US
Practice Address - Phone:808-295-8568
Practice Address - Fax:808-672-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 33841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty