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General NPI Number Information
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NPI Number | 1043368186
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Entity Type | Individual
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Provider Name | ANDREW ROBESON TIDRICK LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 219 W MAGNOLIA ST SUITE 120
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City | FORT COLLINS
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State | CO
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Zip | 80521-2811
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Country | US
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Telephone | 512-691-6025
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Fax | 877-226-2395
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Provider Business Mailing Address
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Address Line | 219 W MAGNOLIA ST SUITE 120
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City | FORT COLLINS
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State | CO
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Zip | 80521-2811
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Country | US
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Telephone | 512-691-6025
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Fax | 877-226-2395
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27843
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09923286
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License Number State | CO
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