Provider Demographics
NPI:1962163451
Name:WHALESONG WELLNESS CORPORATION
Entity type:Organization
Organization Name:WHALESONG WELLNESS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-895-0090
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:KAILUA-KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745
Mailing Address - Country:US
Mailing Address - Phone:808-895-0090
Mailing Address - Fax:
Practice Address - Street 1:73-1103 AHIKAWA ST
Practice Address - Street 2:
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-895-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty