Provider Demographics
NPI:1801526207
Name:LISA CHUN FAT LLC
Entity type:Organization
Organization Name:LISA CHUN FAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHUN FAT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:808-226-0616
Mailing Address - Street 1:2215 BOOTH RD APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6814
Mailing Address - Country:US
Mailing Address - Phone:808-226-0616
Mailing Address - Fax:
Practice Address - Street 1:2176 LAUWILIWILI ST STE 1
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1882
Practice Address - Country:US
Practice Address - Phone:808-226-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty