Healthcare Provider Details

I. General information

NPI: 1730895855
Provider Name (Legal Business Name): KATIA TIKHONRAVOVA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N FEDERAL HWY # D110
POMPANO BEACH FL
33062-1024
US

IV. Provider business mailing address

812 S RIVERSIDE DR
POMPANO BEACH FL
33062-6200
US

V. Phone/Fax

Practice location:
  • Phone: 954-253-2720
  • Fax:
Mailing address:
  • Phone: 954-253-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: