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General NPI Number Information
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NPI Number | 1083010110
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Entity Type | Individual
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Provider Name | MICHAEL ORVILLE MILCETICH-TANO LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 95-632 HANILE ST. G107
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City | MILILANI
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State | HI
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Zip | 96789
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Country | US
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Telephone | 808-343-5590
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Fax |
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Provider Business Mailing Address
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Address Line | 95-632 HANILE ST. G107
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City | MILILANI
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State | HI
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Zip | 96789
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Country | US
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Telephone | 808-343-5590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 776
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License Number State | HI
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