Individual
MS. CAROL TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS. LCPC
Contact information
Practice address
225 S LINDER RD APT A308, EAGLE, ID 83616-4421
(208) 546-1808
Mailing address
225 S LINDER RD APT A308, EAGLE, ID 83616-4421
(208) 794-9502
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-5223
ID
Other
Enumeration date
04/24/2013
Last updated
06/05/2023
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