Provider Demographics
NPI:1063260628
Name:KUOKOA COUNSELING, LLC
Entity type:Organization
Organization Name:KUOKOA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:III
Authorized Official - Credentials:LMHC
Authorized Official - Phone:719-502-1366
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-1197
Mailing Address - Country:US
Mailing Address - Phone:719-502-1366
Mailing Address - Fax:
Practice Address - Street 1:15-2832 MAHIMAHI ST
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-9123
Practice Address - Country:US
Practice Address - Phone:719-502-1366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty