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General NPI Number Information
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NPI Number | 1447660295
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Entity Type | Organization
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Legal Business Name | JENAI TIDWELL LPC PLLC
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 7155 OLD KATY RD SUITE S215
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City | HOUSTON
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State | TX
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Zip | 77024-2134
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Country | US
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Telephone | 832-831-8379
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Fax | 832-831-8388
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Provider Business Mailing Address
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Address Line | 7155 OLD KATY RD SUITE S215
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City | HOUSTON
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State | TX
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Zip | 77024-2134
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Country | US
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Telephone | 832-831-8379
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Fax | 832-831-8388
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Authorized Official
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Title or Position | OWNER
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Name | JENAI DANELLE TIDWELL
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Credential | LPC
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Telephone | 317-523-9275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 69448
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License Number State | TX
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