Provider Demographics
NPI:1295124949
Name:KUSACHI, MIHOKO (LMHC)
Entity type:Individual
Prefix:MS
First Name:MIHOKO
Middle Name:
Last Name:KUSACHI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-1234
Mailing Address - Country:US
Mailing Address - Phone:808-985-7199
Mailing Address - Fax:808-985-7199
Practice Address - Street 1:56 WAIANUENUE AVE
Practice Address - Street 2:#8
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2474
Practice Address - Country:US
Practice Address - Phone:808-769-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health