Provider Demographics
NPI:1447624556
Name:BIG ISLAND HEALTH CLINIC
Entity type:Organization
Organization Name:BIG ISLAND HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KANAELE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-747-2034
Mailing Address - Street 1:58 KINOOLE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2490
Mailing Address - Country:US
Mailing Address - Phone:808-747-2034
Mailing Address - Fax:
Practice Address - Street 1:58 KINOOLE ST STE 106
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2490
Practice Address - Country:US
Practice Address - Phone:808-747-2034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty