Provider Demographics
NPI:1922408020
Name:KOKUA SUPPORT SERVICES
Entity Type:Organization
Organization Name:KOKUA SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRISTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSCP,CSAC, SAP
Authorized Official - Phone:808-847-5777
Mailing Address - Street 1:PO BOX 17870
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-0870
Mailing Address - Country:US
Mailing Address - Phone:808-847-4227
Mailing Address - Fax:
Practice Address - Street 1:1803 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3451
Practice Address - Country:US
Practice Address - Phone:808-847-4227
Practice Address - Fax:808-842-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10694948101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 101YP2500X, 103K00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========OtherALL INSURANCE
HI=========Medicaid
HI=========Medicare Oscar/Certification
HI=========OtherALL INSURANCE