Healthcare Provider Details

I. General information

NPI: 1063175883
Provider Name (Legal Business Name): TIDAL CONSULTING & THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28302 ALTMAN CT
SALISBURY MD
21801-2088
US

IV. Provider business mailing address

28302 ALTMAN CT
SALISBURY MD
21801-2088
US

V. Phone/Fax

Practice location:
  • Phone: 410-924-4897
  • Fax:
Mailing address:
  • Phone: 410-924-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN JOY ELLIS
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 410-924-4897