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NPI Code Detail

MEDICARE: TIFFANY TIDWELL

MEDICARE: TIFFANY TIDWELL
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1033883368
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY TIDWELL
Provider Business Mailing Address
First Line : 10233 E NORTHWEST HWY STE 436
Second Line :
City : DALLAS
State : TX
Zip : 75238-4418
Country : US
Telephone Number : 972-501-9917
Fax Number :
Provider Business Practice Location Address
First Line : 10233 E NORTHWEST HWY STE 436
Second Line :
City : DALLAS
State : TX
Zip : 75238-4418
Country : US
Telephone Number : 972-501-9917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2021
Last Update Date : 08/02/2021

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Directions to “ TIFFANY TIDWELL ” Practice Location

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