Basic Information
| Provider Information | |||||||||
| NPI: | 1013666262 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEELY | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 COYNE ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083211633 | ||||||||
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| Practice Location | |||||||||
| Address1: | 203 KAPAA QUARRY PLAZA | ||||||||
| Address2: | #5002 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087412232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2022 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.