Provider Demographics
NPI:1881309250
Name:UNITED THERAPIST GROUP USA, LLC
Entity type:Organization
Organization Name:UNITED THERAPIST GROUP USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKHONRAVOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-253-2720
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 STE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT3336OtherBOARD OF CLINICAL SOCIAL WORK, MARRIAGE AND FAMILY THERAPY AND MHC