Healthcare Provider Details

I. General information

NPI: 1700583069
Provider Name (Legal Business Name): TYLORE SHEIGH GROSS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 ASHWORTH RD STE 210
WEST DES MOINES IA
50266-5954
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 515-854-3618
  • Fax: 515-644-8225
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138690
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number13295
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: