Provider Demographics
NPI:1609026384
Name:YASUTAKE, TAMI KEAKAOKALANI MOIKEHA (LMFT-256)
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:KEAKAOKALANI MOIKEHA
Last Name:YASUTAKE
Suffix:
Gender:F
Credentials:LMFT-256
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:KEAKA
Other - Last Name:YAUSUTAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT-256
Mailing Address - Street 1:571 KAMALU RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-9618
Mailing Address - Country:US
Mailing Address - Phone:808-937-0512
Mailing Address - Fax:
Practice Address - Street 1:4-885 KUHIO HWY # A-1
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2702
Practice Address - Country:US
Practice Address - Phone:808-937-0512
Practice Address - Fax:808-822-5454
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI734542Medicaid
HIIN PROCESSOtherKAISER
HI0000321034OtherHMSA