Basic Information
| Provider Information | |||||||||
| NPI: | 1922415280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC WELLNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 KAMAKEE ST | ||||||||
| Address2: | SUITE 417 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083721952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 KAMAKEE ST | ||||||||
| Address2: | SUITE 417 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083721952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2014 | ||||||||
| LastUpdateDate: | 12/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | HOGAN | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8083721952 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 321 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.