Provider Demographics
NPI:1891456133
Name:LAWRENCE, LYDELL TUPUONO (MHC)
Entity type:Individual
Prefix:
First Name:LYDELL
Middle Name:TUPUONO
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55-455 MOANA ST # A
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1123
Mailing Address - Country:US
Mailing Address - Phone:808-751-0774
Mailing Address - Fax:
Practice Address - Street 1:224 KAMEHAMEHA AVE # 201
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2860
Practice Address - Country:US
Practice Address - Phone:808-825-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
HI1048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor