Provider Demographics
NPI:1518222405
Name:CROSS, TIFFANY LEIGH (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:CROSS
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 CHERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8553
Mailing Address - Country:US
Mailing Address - Phone:817-980-7473
Mailing Address - Fax:
Practice Address - Street 1:6849 ELM ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4228
Practice Address - Country:US
Practice Address - Phone:817-980-7473
Practice Address - Fax:866-612-2084
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional