Provider Demographics
NPI:1669831723
Name:TINY LITTLE JEWELS, LLC
Entity type:Organization
Organization Name:TINY LITTLE JEWELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW, MPH, CPH
Authorized Official - Phone:813-609-2655
Mailing Address - Street 1:PO BOX 6823
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33608-0823
Mailing Address - Country:US
Mailing Address - Phone:813-609-2655
Mailing Address - Fax:
Practice Address - Street 1:323 VINE CLIFF ST
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4935
Practice Address - Country:US
Practice Address - Phone:813-609-2655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 128681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty