Provider Demographics
NPI:1992468649
Name:KOKUA MENTAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:KOKUA MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GINO
Authorized Official - Middle Name:BON
Authorized Official - Last Name:TITUS-LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, QMHP
Authorized Official - Phone:808-204-5691
Mailing Address - Street 1:1188 BISHOP ST STE 1411
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3306
Mailing Address - Country:US
Mailing Address - Phone:808-501-0501
Mailing Address - Fax:808-470-6202
Practice Address - Street 1:1188 BISHOP ST STE 1411
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3306
Practice Address - Country:US
Practice Address - Phone:808-501-0501
Practice Address - Fax:808-470-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty