Healthcare Provider Details

I. General information

NPI: 1942325246
Provider Name (Legal Business Name): SVETLANA V. TIKHONOVA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4966 EL CAMINO REAL #216
LOS ALTOS CA
94022-1436
US

IV. Provider business mailing address

4966 EL CAMINO REAL #216
LOS ALTOS CA
94022-1436
US

V. Phone/Fax

Practice location:
  • Phone: 650-388-6747
  • Fax:
Mailing address:
  • Phone: 650-388-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT#79777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: