Provider Demographics
NPI:1063176048
Name:ASADA, CRYSTAL (LMFT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ASADA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:ASADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSCP
Mailing Address - Street 1:1217 UKANA STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1131
Mailing Address - Country:US
Mailing Address - Phone:808-551-0238
Mailing Address - Fax:
Practice Address - Street 1:1217 UKANA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-1131
Practice Address - Country:US
Practice Address - Phone:808-551-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
HIMFT918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent