Provider Demographics
NPI:1538794201
Name:IKE LOA THERAPEUTIC SERVICES, INC
Entity type:Organization
Organization Name:IKE LOA THERAPEUTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEAIAKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-220-3665
Mailing Address - Street 1:1520 LILIHA ST STE 406
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3564
Mailing Address - Country:US
Mailing Address - Phone:714-584-9889
Mailing Address - Fax:808-600-3754
Practice Address - Street 1:1520 LILIHA ST STE 406
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3564
Practice Address - Country:US
Practice Address - Phone:714-584-9889
Practice Address - Fax:808-600-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty