Basic Information
| Provider Information | |||||||||
| NPI: | 1811531338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALOHA MENTAL WELLNESS LLC | ||||||||
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| OtherOrganizationName: | ALOHA FAMILY PSYCHIATRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 QUEEN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082102111 | ||||||||
| FaxNumber: | 8332925812 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 QUEEN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082102111 | ||||||||
| FaxNumber: | 8332925812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2019 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | TYRRELL | ||||||||
| AuthorizedOfficialFirstName: | SOONJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8085943011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN, PMHNP-BC | ||||||||
| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 2084P0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.