Provider Demographics
NPI:1427455997
Name:FAMILY TREE PROJECT, LLP
Entity type:Organization
Organization Name:FAMILY TREE PROJECT, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:808-778-6797
Mailing Address - Street 1:PO BOX 970010
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0010
Mailing Address - Country:US
Mailing Address - Phone:808-778-6797
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD STE 133
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2097
Practice Address - Country:US
Practice Address - Phone:808-778-6797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHANA KOA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-29
Last Update Date:2014-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-340, MHC-348251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health