Provider Demographics
NPI:1750002515
Name:GATES, KEELY MOANI
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:MOANI
Last Name:GATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-807 KAHAKAI BLVD
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-9658
Mailing Address - Country:US
Mailing Address - Phone:831-227-7199
Mailing Address - Fax:
Practice Address - Street 1:83 MAIKAI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5364
Practice Address - Country:US
Practice Address - Phone:808-664-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician