Provider Demographics
NPI:1932648474
Name:DORENE TOUTANT LLC
Entity Type:Organization
Organization Name:DORENE TOUTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:TOUTANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-755-8726
Mailing Address - Street 1:1704 WILI PA LOOP
Mailing Address - Street 2:272
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1240
Mailing Address - Country:US
Mailing Address - Phone:626-755-8726
Mailing Address - Fax:
Practice Address - Street 1:50 KAUKINI LOOP
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-5755
Practice Address - Country:US
Practice Address - Phone:626-755-8726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4199251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health