Organization
OLA PONO COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AUGUSTO DAQUIPA GANCINIA II PHD (OWNER)
(385) 446-2466
Entity
Organization
Contact information
Practice address
455 N UNIVERSITY AVE STE 201, PROVO, UT 84601-2867
(385) 446-2466
(385) 446-2466
Mailing address
455 N UNIVERSITY AVE STE 201, PROVO, UT 84601-2867
(385) 446-2466
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Enumeration date
10/04/2024
Last updated
10/04/2024
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