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75-5995 Kuakini Hwy. Ste 900 Kailua-kona HI 96740 | |
| (808) 333-8988 | |
| (808) 464-4257 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 75-5995 Kuakini Hwy., Kailua-kona, Hawaii |
| Authorized Official Name and Position | Nancy M Sallee (OWNER) |
| Authorized Official Contact | 8083338988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
77-401 Pu'uwai Ali'i Place Kailua-kona HI 96740 Ph: (808) 333-8988 | 75-5995 Kuakini Hwy. Ste 900 Kailua-kona HI 96740 Ph: (808) 333-8988 |
| NPI Number | 1376055046 |
|---|---|
| Provider Enumeration Date | 11/02/2017 |
| Last Update Date | 11/02/2017 |
| Medicare PECOS PAC ID | 6103361571 |
|---|---|
| Medicare Enrollment ID | O20240710000103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376055046 | NPI | - | NPPES |
| 612524-01 | Medicaid | HI | |
| 612524-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | MFT154 (Hawaii) | Primary |
| 106H00000X | Marriage & Family Therapist | MFCC38611 (California) | Secondary |
| Provider Name | Nancy M Sallee |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972672954 PECOS PAC ID: 6002351475 Enrollment ID: I20240710000160 |
The Green Room Therapy, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 78-6831 Alii Drive, Space E234, Unit # 211, Kailua-kona, HI 96740 Phone: 808-234-4435 | |
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