=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295434447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDFUL SOLUTIONS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2023
-----------------------------------------------------
Last Update Date | 02/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95-632 HANILE ST. G107
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-2862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-343-5590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95-632 HANILE ST. G107
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-2862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-343-5590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER, CEO AND THERAPIST
-----------------------------------------------------
Name | MR. MICHAEL ORVILLE MILCETICH-TANO
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 808-343-5590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------