Individual
ELYSIA N TIDEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 LINCOLN WAY E, SOUTH BEND, IN 46601-3212
(574) 360-4066
(866) 843-2486
Mailing address
611 LINCOLN WAY E, SOUTH BEND, IN 46601-3212
(574) 360-4066
(866) 843-2486
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
IN
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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