Healthcare Provider Details

I. General information

NPI: 1679149496
Provider Name (Legal Business Name): SHARLA SKINNER TISDALE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18551 CHAMPION FOREST DR STE 103
SPRING TX
77379-5582
US

IV. Provider business mailing address

18551 CHAMPION FOREST DR STE 103
SPRING TX
77379-5582
US

V. Phone/Fax

Practice location:
  • Phone: 713-819-6104
  • Fax:
Mailing address:
  • Phone: 713-819-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: