Provider Demographics
NPI:1043190754
Name:HALEAKALA COUNSELING COLLECTIVE LLC
Entity type:Organization
Organization Name:HALEAKALA COUNSELING COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANGLALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-724-1634
Mailing Address - Street 1:100 IHE PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8903
Mailing Address - Country:US
Mailing Address - Phone:808-724-1634
Mailing Address - Fax:
Practice Address - Street 1:100 IHE PL UNIT B
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8903
Practice Address - Country:US
Practice Address - Phone:808-724-1634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty