Provider Demographics
NPI:1457076150
Name:GOMES, GARRETT (MFT)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:GOMES
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-374 NAMOKU ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2260
Mailing Address - Country:US
Mailing Address - Phone:808-292-9954
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST STE 412
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2533
Practice Address - Country:US
Practice Address - Phone:808-292-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty