Provider Demographics
NPI:1922357375
Name:PSYCHIATRIC CLINIC INC
Entity Type:Organization
Organization Name:PSYCHIATRIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILI
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-664-1104
Mailing Address - Street 1:PO BOX 37862
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96837-0862
Mailing Address - Country:US
Mailing Address - Phone:808-664-1104
Mailing Address - Fax:866-592-3149
Practice Address - Street 1:928 NUUANU AVE
Practice Address - Street 2:SUITE LL2
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5190
Practice Address - Country:US
Practice Address - Phone:808-538-2800
Practice Address - Fax:808-536-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 134342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty