Provider Demographics
NPI:1053722512
Name:HESS, AMANDA LOUISE (MSC, LMFT, LMHC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LOUISE
Last Name:HESS
Suffix:
Gender:F
Credentials:MSC, LMFT, LMHC
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:LOUISE
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSC, LMFT, LMHC
Mailing Address - Street 1:PO BOX 700024
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-0024
Mailing Address - Country:US
Mailing Address - Phone:808-518-2090
Mailing Address - Fax:808-376-0731
Practice Address - Street 1:2176 LAUWILIWILI ST STE 1
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1882
Practice Address - Country:US
Practice Address - Phone:808-518-2090
Practice Address - Fax:808-376-0731
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHILMFT-506106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI789430Medicaid