Provider Demographics
NPI:1083010110
Name:MILCETICH-TANO, MICHAEL ORVILLE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ORVILLE
Last Name:MILCETICH-TANO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-632 HANILE ST.
Mailing Address - Street 2:G107
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789
Mailing Address - Country:US
Mailing Address - Phone:808-343-5590
Mailing Address - Fax:
Practice Address - Street 1:95-632 HANILE ST.
Practice Address - Street 2:G107
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789
Practice Address - Country:US
Practice Address - Phone:808-343-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
HI776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist