Provider Demographics
NPI:1063155398
Name:MILLS, KELSEY JENNIFER PUANANI
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JENNIFER PUANANI
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3418
Mailing Address - Country:US
Mailing Address - Phone:808-495-1505
Mailing Address - Fax:
Practice Address - Street 1:420 WAIAKAMILO RD STE 300B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4950
Practice Address - Country:US
Practice Address - Phone:808-832-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker