Most Relevant Information
Provider Data
| NPI Number: | 1003250754 |
| Provider Name: | CAROL TIDWELL MS. LCPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | LCPC-5223 |
Most Important Dates
| Enumeration Date: | 04/24/2013 |
| Last Updated: | 06/05/2023 |
Provider Practice Location
225 S LINDER RD APT A308
EAGLE
ID
836164421
Practice Location Phone/Fax
| Phone: | 2085461808 |
| Fax: |
Provider Mailing Location
225 S LINDER RD APT A308
EAGLE
ID
836164421
Provider Mailing Phone/Fax
| Phone: | 2087949502 |
| Fax: |