The Lavender Clinic

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

THE LAVENDER CLINIC

Practice address

1481 S King St Ste 422
Honolulu, HI 96814-2600

Phone

(808) 744-2543

Fax

(866) 451-4608

NPI assigned

Oct 6, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Stephanie Mikhail

Title

Director of Operations

Phone

(808) 744-2543

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• The Lavender Center & Clinic Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1346643236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1481 S KING ST STE 422",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968142600",
            "telephone_number": "808-744-2543",
            "fax_number": "866-451-4608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1481 S KING ST STE 422",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968142600",
            "telephone_number": "808-744-2543",
            "fax_number": "866-451-4608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAVENDER CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-06",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "MIKHAIL",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "808-744-2543",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "835481",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lavender Center & Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.