Provider Demographics
NPI:1386942225
Name:SOUZA, JOHN G JR (LMFT, DMFT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:SOUZA
Suffix:JR
Gender:M
Credentials:LMFT, DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 KAIKUONO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1730
Mailing Address - Country:US
Mailing Address - Phone:808-657-5507
Mailing Address - Fax:
Practice Address - Street 1:234 WAIANUENUE AVE STE 218
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2418
Practice Address - Country:US
Practice Address - Phone:808-657-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2252106H00000X
HIMFT-397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty