Provider Demographics
NPI:1730895855
Name:TIKHONRAVOVA, KATIA (PHD)
Entity type:Individual
Prefix:DR
First Name:KATIA
Middle Name:
Last Name:TIKHONRAVOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 S RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-6200
Mailing Address - Country:US
Mailing Address - Phone:954-253-2720
Mailing Address - Fax:
Practice Address - Street 1:2101 N FEDERAL HWY # D110
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1024
Practice Address - Country:US
Practice Address - Phone:954-253-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist