Provider Demographics
NPI:1700591526
Name:ANUENUE PSYCHOLOGICAL SERVICE, LLC
Entity Type:Organization
Organization Name:ANUENUE PSYCHOLOGICAL SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-480-0072
Mailing Address - Street 1:PO BOX 701152
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-1152
Mailing Address - Country:US
Mailing Address - Phone:808-481-0072
Mailing Address - Fax:
Practice Address - Street 1:99-080 KAUHALE ST STE C20
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4114
Practice Address - Country:US
Practice Address - Phone:808-481-0072
Practice Address - Fax:808-437-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1518406081OtherNPI