Provider Demographics
NPI:1346424850
Name:SIPOLT, MELISSA FRANCES (MFT-420 HAWAII)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:FRANCES
Last Name:SIPOLT
Suffix:
Gender:F
Credentials:MFT-420 HAWAII
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:F
Other - Last Name:SIPOLT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT44280 CALIFORNIA
Mailing Address - Street 1:384 KAIMAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2019
Mailing Address - Country:US
Mailing Address - Phone:808-688-4228
Mailing Address - Fax:808-260-9880
Practice Address - Street 1:93 N KAINALU DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2331
Practice Address - Country:US
Practice Address - Phone:808-688-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT44280106H00000X
HIMFT-420106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346424850OtherNPI