Individual
TIFFANY NICOLE CRUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
870 MAIN ST, FAYETTE, MS 39069-5695
(601) 786-3401
(601) 786-3400
Mailing address
PO BOX 870, FAYETTE, MS 39069-0870
(601) 532-0995
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2913
MS
Other
Enumeration date
03/07/2023
Last updated
03/07/2023
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