Provider Demographics
NPI:1063934560
Name:CROSS FAMILY COUNSELING, PLLC
Entity type:Organization
Organization Name:CROSS FAMILY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-323-0674
Mailing Address - Street 1:1710 MARSEILLE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9004
Mailing Address - Country:US
Mailing Address - Phone:850-323-0674
Mailing Address - Fax:
Practice Address - Street 1:913 GULF BREEZE PKWY STE 26A
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4731
Practice Address - Country:US
Practice Address - Phone:850-323-0674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH1508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty