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General NPI Number Information
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NPI Number | 1861308702
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Entity Type | Individual
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Provider Name | STEPHEN TIDWELL
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Gender | Male
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Dates
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Enumeration Date | 08/20/2026
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Last Update Date | 08/20/2026
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Provider Practice Location Address
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Address Line | 120 TWO MILE PIKE
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-1832
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Country | US
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Telephone | 615-239-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 115 GREENLAWN DR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-4735
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Country | US
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Telephone | 615-239-1404
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 16892
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License Number State | TN
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