Healthcare Provider Details

I. General information

NPI: 1720982358
Provider Name (Legal Business Name): TISDALE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W CAPITOL AVE STE 222
LITTLE ROCK AR
72201-3440
US

IV. Provider business mailing address

425 W CAPITOL AVE STE 222
LITTLE ROCK AR
72201-3440
US

V. Phone/Fax

Practice location:
  • Phone: 501-830-1727
  • Fax: 501-498-7384
Mailing address:
  • Phone: 501-830-1727
  • Fax: 501-498-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: AUSTIN TISDALE
Title or Position: MANAGER
Credential: LCSW
Phone: 501-830-1727