Ms. Carol Tidwell
Mental Health Counselor
11104 W State St
Star
, Idaho 83669
Ms. Carol Tidwell
Mental Health Counselor
11104 W State St
Star
, Idaho 83669
(208) 794-9502
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About
Features
Specialties
- Mental Health Counselor
Languages spoken
- English
Location
First Address
- Ms. Carol Tidwell
- 2205 W Breneman St
- Boise, ID
- Zip : 83702-0540
- Phone : (208) 794-9502
Second Address
- Ms. Carol Tidwell
- 11104 W State St
- Star, ID
- Zip : 83669
- Phone : (208) 546-1808
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 101YM0800X | Mental Health Counselor | LCPC-5223 | ID |
National Provider Identifier
| NPI | 1003250754 |
|---|---|
| Provider Name | Ms. Carol Tidwell |
| First Address | Boise, ID 83702-0540 |
| Second Address | Star, ID 83669 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/04/2013 |
| Last Update Date | 24/04/2013 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.