MEDICARE: MRS. DOROTHY TIEDT L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	16966	TX
2	101YP2500X	Professional Counselor	16966	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	468632	OTHER	TX	VALUE OPTIONS

General Provider Information

NPI Number	:	1003984329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOROTHY TIEDT L.P.C.

Provider Business Mailing Address
First Line	:	8738 RIPPLING WATER DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6975
Country	:	US
Telephone Number	:	713-412-5524
Fax Number	:	281-937-0201

Provider Business Practice Location Address
First Line	:	2825 WILCREST DR
Second Line	:	SUITE 112
City	:	HOUSTON
State	:	TX
Zip	:	77042-3391
Country	:	US
Telephone Number	:	713-412-5524
Fax Number	:	281-937-0201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/11/2025

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