Provider Demographics
NPI:1396266888
Name:GROTE, ELIZABETH MAY BOADICEA BUTLER (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAY BOADICEA BUTLER
Last Name:GROTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 AUKAI AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5207
Mailing Address - Country:US
Mailing Address - Phone:808-382-2207
Mailing Address - Fax:
Practice Address - Street 1:1130 KOKO HEAD AVE STE 2
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3771
Practice Address - Country:US
Practice Address - Phone:808-520-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist