Provider Demographics
NPI:1174380539
Name:FAMILY AND GROUP THERAPY , A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:FAMILY AND GROUP THERAPY , A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKHONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:650-793-4642
Mailing Address - Street 1:4966 EL CAMINO REAL STE 216
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1458
Mailing Address - Country:US
Mailing Address - Phone:650-793-4642
Mailing Address - Fax:
Practice Address - Street 1:4966 EL CAMINO REAL STE 216
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1458
Practice Address - Country:US
Practice Address - Phone:650-793-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty