Healthcare Provider Details

I. General information

NPI: 1790908457
Provider Name (Legal Business Name): TAMAI TISDALE QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 N WESTMORELAND RD
DALLAS TX
75211-1655
US

IV. Provider business mailing address

516 SUMAC PL
DESOTO TX
75115-3829
US

V. Phone/Fax

Practice location:
  • Phone: 214-333-7031
  • Fax:
Mailing address:
  • Phone: 214-333-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: