Provider Demographics
NPI:1700212073
Name:TANAKA, TIFFANY HT (MFT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:HT
Last Name:TANAKA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 ALA NAPUNANI ST APT 203
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1785
Mailing Address - Country:US
Mailing Address - Phone:808-372-8875
Mailing Address - Fax:
Practice Address - Street 1:1080 ALA NAPUNANI ST APT 203
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-1785
Practice Address - Country:US
Practice Address - Phone:808-372-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist