Provider Demographics
NPI:1265790828
Name:KOSAKA, MEGAN (MA MFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KOSAKA
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:346 HOKULANI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8613
Mailing Address - Country:US
Mailing Address - Phone:808-298-8115
Mailing Address - Fax:
Practice Address - Street 1:346 HOKULANI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8613
Practice Address - Country:US
Practice Address - Phone:808-298-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
HI332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist