Healthcare Provider Details

I. General information

NPI: 1932425386
Provider Name (Legal Business Name): TINA ANN BOTEILHO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 WILI PA LOOP SUITE 7
WAILUKU HI
96793-1280
US

IV. Provider business mailing address

1787 WILI PA LOOP SUITE 7
WAILUKU HI
96793-1280
US

V. Phone/Fax

Practice location:
  • Phone: 808-249-2121
  • Fax:
Mailing address:
  • Phone: 808-249-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number388
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: