Provider Demographics
NPI:1114218625
Name:MENTAL HEALTH KOKUA
Entity type:Organization
Organization Name:MENTAL HEALTH KOKUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ED
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-737-2523
Mailing Address - Street 1:680 IWILEI RD STE 600
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5393
Mailing Address - Country:US
Mailing Address - Phone:808-737-2523
Mailing Address - Fax:808-734-1208
Practice Address - Street 1:680 IWILEI RD STE 600
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5393
Practice Address - Country:US
Practice Address - Phone:808-737-2523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1033258348OtherHAWAII DEPARTMENT OF HEALTH, ADULT MENTAL HEALTH DIVISION