Provider Demographics
NPI:1295243152
Name:AHUPUAA COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:AHUPUAA COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOTEILHO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-283-8640
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0852
Mailing Address - Country:US
Mailing Address - Phone:808-283-8640
Mailing Address - Fax:808-633-8425
Practice Address - Street 1:357 HUKU LII PL STE B201
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8998
Practice Address - Country:US
Practice Address - Phone:808-283-8640
Practice Address - Fax:808-283-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI388106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty