Individual provider Active NPI

Tanja Nikolic, LMFT

  • Marriage & Family Therapist
  • Honolulu, HI
National Provider Identifier
1134880289
Registry record updated Dec 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT-719 Issued in HI
Practice address
4075 Koko Dr
Honolulu, HI 96816-4357
Phone
(808) 386-3307
NPI assigned
Dec 30, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT-719 HI Primary

Addresses

Primary practice location

4075 Koko Dr
Honolulu, HI 96816-4357

Mailing address

4075 Koko Dr
Honolulu, HI 96816-4357
Phone (808) 386-3307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250926003448 HI Practitioner - Marriage and Family Therapist 2466957295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Honolulu, HI 96816
Phone (808) 386-3307

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MFT-719HIMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Counseling LLC Marriage & Family Therapist CurrentSince Jul 26, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701475200000",
    "number": "1134880289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4075 KOKO DR",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968164357",
            "telephone_number": "808-386-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4075 KOKO DR",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968164357",
            "telephone_number": "808-386-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKOLIC",
        "first_name": "TANJA",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-30",
        "last_updated": "2023-12-02",
        "certification_date": "2023-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "MFT-719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.