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General NPI Number Information
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NPI Number | 1063934560
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Entity Type | Organization
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Legal Business Name | CROSS FAMILY COUNSELING, PLLC
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 913 GULF BREEZE PKWY STE 26A
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City | GULF BREEZE
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State | FL
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Zip | 32561-4731
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Country | US
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Telephone | 850-323-0674
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 MARSEILLE DR
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City | GULF BREEZE
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State | FL
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Zip | 32563-9004
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Country | US
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Telephone | 850-323-0674
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/OWNER
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Name | TIFFANY CROSS
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Credential |
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Telephone | 850-323-0674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PMH1508
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License Number State | FL
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