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NPI Code Detail

MEDICARE: ARMONTE DESHAWEN TIDWELL

MEDICARE: ARMONTE DESHAWEN 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
1101YA0400XAddiction (Substance Use Disorder) Counselor19119CA

General Provider Information

NPI Number : 1427755610
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARMONTE DESHAWEN TIDWELL
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 200
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-4971
Country : US
Telephone Number : 818-826-1033
Fax Number :
Provider Business Practice Location Address
First Line : 21600 OXNARD ST STE 200
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-4971
Country : US
Telephone Number : 877-207-1009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2023
Last Update Date : 01/20/2026

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Directions to “ ARMONTE DESHAWEN TIDWELL ” Practice Location

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