Provider Demographics
NPI:1104401090
Name:STEVENS, MELISSA ANN UILANI MANUEL (LMFT, LMHC, CSAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN UILANI MANUEL
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMFT, LMHC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-278 KUPULAU PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1831
Mailing Address - Country:US
Mailing Address - Phone:808-636-5989
Mailing Address - Fax:
Practice Address - Street 1:94-278 KUPULAU PL
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1831
Practice Address - Country:US
Practice Address - Phone:808-636-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HIMFT-694106H00000X
HI684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist