Provider Demographics
NPI:1700583069
Name:GROSS, TYLORE SHEIGH (PLMHP)
Entity Type:Individual
Prefix:
First Name:TYLORE
Middle Name:SHEIGH
Last Name:GROSS
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9029 BURT ST APT 110
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2435
Mailing Address - Country:US
Mailing Address - Phone:402-670-8929
Mailing Address - Fax:
Practice Address - Street 1:10791 S 72ND ST STE 101
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3403
Practice Address - Country:US
Practice Address - Phone:402-403-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
NE13295101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health