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NPI Code Detail

MEDICARE: ANGELA TIDWELL

MEDICARE: ANGELA 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) Counselor

General Provider Information

NPI Number : 1427814706
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA TIDWELL
Provider Business Mailing Address
First Line : 1001 WALLACE BLVD
Second Line :
City : AMARILLO
State : TX
Zip : 79106-1735
Country : US
Telephone Number : 806-214-1130
Fax Number :
Provider Business Practice Location Address
First Line : 1001 WALLACE BLVD
Second Line :
City : AMARILLO
State : TX
Zip : 79106-1735
Country : US
Telephone Number : 806-214-1130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2024
Last Update Date : 02/26/2024

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Directions to “ ANGELA TIDWELL ” Practice Location

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