Provider Demographics
NPI:1336983535
Name:MALAMA SERENITY PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:MALAMA SERENITY PSYCHOTHERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:SERENITY
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-909-2006
Mailing Address - Street 1:99-115 AIEA HEIGHTS DR STE 219A
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3974
Mailing Address - Country:US
Mailing Address - Phone:808-909-2006
Mailing Address - Fax:808-909-3818
Practice Address - Street 1:99-115 AIEA HEIGHTS DR STE 219A
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3974
Practice Address - Country:US
Practice Address - Phone:808-909-2006
Practice Address - Fax:808-909-3818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty