Individual
KELLIE JOHNSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, CST
Contact information
Practice address
970 N KALAHEO AVE STE A212, KAILUA, HI 96734-1857
(808) 753-3329
Mailing address
51-015 LAU PL, KAAAWA, HI 96730-9817
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
HI-731
HI
106H00000X
Marriage & Family Therapist
Primary
MFT-731
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164921615
—
HI
Enumeration date
02/09/2018
Last updated
11/16/2022
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