Individual
MRS. MCKENZIE S TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C2219A
AL
101YP2500X
Professional Counselor
Primary
3494
AL
Other
Enumeration date
02/05/2014
Last updated
02/14/2022
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