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General NPI Number Information
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NPI Number | 1326286840
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Entity Type | Individual
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Provider Name | SARAH ANNE TISDALE MFT 79763
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Gender | Female
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Dates
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Enumeration Date | 01/22/2009
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 380 ENCINAL ST STE 200
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City | SANTA CRUZ
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State | CA
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Zip | 95060-2178
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Country | US
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Telephone | 318-269-3623
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Fax | 833-371-1900
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Provider Business Mailing Address
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Address Line | PO BOX 2634
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City | SANTA CRUZ
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State | CA
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Zip | 95063-2634
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 79763
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License Number State | CA
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