Provider Demographics
NPI:1194111591
Name:THALIA REITKOPF LMHC, PA
Entity type:Organization
Organization Name:THALIA REITKOPF LMHC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMHC
Authorized Official - Prefix:
Authorized Official - First Name:THALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REITKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-335-3185
Mailing Address - Street 1:17501 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17501 BISCAYNE BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4802
Practice Address - Country:US
Practice Address - Phone:305-335-3185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-10421101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty