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General NPI Number Information
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NPI Number | 1093351629
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Entity Type | Organization
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Legal Business Name | TIDAL COUNSELING LLC
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 1490 NORTHBANK PKWY SUITE 248
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2439
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Country | US
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Telephone | 205-722-7227
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 NORTHBANK PKWY SUITE 248
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2439
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Country | US
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Telephone | 205-722-7227
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELING
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Name | MOLLIE OLINE PUTYRAE
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Credential | MA
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Telephone | 509-981-3104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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