Provider Demographics
NPI:1679716575
Name:CUTLER, TIFFANY GRIVAS (LMHC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GRIVAS
Last Name:CUTLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:S
Other - Last Name:GRIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16199 SHELLCRACKER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-4908
Mailing Address - Country:US
Mailing Address - Phone:386-697-6639
Mailing Address - Fax:
Practice Address - Street 1:16199 SHELLCRACKER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-4908
Practice Address - Country:US
Practice Address - Phone:386-697-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH11912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health