Individual
DR. ALICIA ELLEN TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5101 WILLOW POND DRIVE, WEST BLOOMFIELD, MI 48323
(248) 974-1783
Mailing address
5101 WILLOW POND DR, WEST BLOOMFIELD, MI 48323-2094
(248) 706-1453
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301003007
MI
103TC0700X
Clinical Psychologist
6301003007
MI
Other
Enumeration date
08/04/2006
Last updated
10/30/2025
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