Individual
PATRICK R TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D, LMFT
Contact information
Practice address
1425 I-65 PARKWAY, MONTGOMERY, AL 36106-2860
(404) 989-2867
Mailing address
3884 BERKSHIRE DR, MONTGOMERY, AL 36109-1641
(334) 787-0601
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
251S00000X
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251S00000X
—
AL
Enumeration date
11/06/2017
Last updated
11/06/2017
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