Provider Demographics
NPI:1932089240
Name:SIRENITY TIDE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SIRENITY TIDE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:316-708-7217
Mailing Address - Street 1:8110 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2037
Mailing Address - Country:US
Mailing Address - Phone:316-708-7217
Mailing Address - Fax:
Practice Address - Street 1:8110 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-2037
Practice Address - Country:US
Practice Address - Phone:316-708-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty