Basic Information
| Provider Information | |||||||||
| NPI: | 1922444843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S.C.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-1210 KAILEOLEA DR | ||||||||
| Address2: | 2L2 | ||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967066241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083721952 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 WARD AVE | ||||||||
| Address2: | SUITE 219B | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085851424 | ||||||||
| FaxNumber: | 8085850379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2013 | ||||||||
| LastUpdateDate: | 05/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | HI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.