Provider Demographics
NPI:1457363897
Name:RALSTON, GARY G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:RALSTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3301
Mailing Address - Country:US
Mailing Address - Phone:808-533-3850
Mailing Address - Fax:808-533-3583
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE 2204
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-533-3850
Practice Address - Fax:808-533-3583
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05741901Medicaid
HI3751Medicare UPIN
HI05741901Medicaid
HIH0000TCBVLMedicare ID - Type Unspecified