Provider Demographics
NPI:1184018665
Name:CROSS, TYRENIA OCTAVIA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TYRENIA
Middle Name:OCTAVIA
Last Name:CROSS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16462 TISONS BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8993
Mailing Address - Country:US
Mailing Address - Phone:904-323-2996
Mailing Address - Fax:
Practice Address - Street 1:7235 BONNEVAL RD
Practice Address - Street 2:SUITE# 205
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7565
Practice Address - Country:US
Practice Address - Phone:904-323-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health