Provider Demographics
NPI:1992023832
Name:ELLIOTT PLOURDE
Entity Type:Organization
Organization Name:ELLIOTT PLOURDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MST THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOURDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-777-8291
Mailing Address - Street 1:1485 LINAPUNI ST RM 105
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3575
Mailing Address - Country:US
Mailing Address - Phone:808-777-8291
Mailing Address - Fax:
Practice Address - Street 1:1485 LINAPUNI ST RM 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3575
Practice Address - Country:US
Practice Address - Phone:808-777-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health