Provider Demographics
NPI:1932744307
Name:INTEGRATIVE PSYCHOLOGICAL SERVICES HAWAI'I, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL SERVICES HAWAI'I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-829-1851
Mailing Address - Street 1:PO BOX 22611
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2611
Mailing Address - Country:US
Mailing Address - Phone:808-829-1851
Mailing Address - Fax:
Practice Address - Street 1:1029 KAPAHULU AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-829-1851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty