Provider Demographics
NPI:1194323667
Name:MAEA, TAVITA III (LMFT)
Entity type:Individual
Prefix:MR
First Name:TAVITA
Middle Name:
Last Name:MAEA
Suffix:III
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 1:95-754 HOKUWELOWELO PL APT M102
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2952
Mailing Address - Country:US
Mailing Address - Phone:808-450-5772
Mailing Address - Fax:
Practice Address - Street 1:95-754 HOKUWELOWELO PL APT M102
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2952
Practice Address - Country:US
Practice Address - Phone:808-450-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist