Individual
MICHAEL TIDSTRAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA, MA, LPCC
Contact information
Practice address
20112 RUNNYMEDE ST UNIT 5, WINNETKA, CA 91306-2901
(818) 216-0321
Mailing address
20112 RUNNYMEDE ST UNIT 5, WINNETKA, CA 91306-2901
(818) 216-0321
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPCC7019
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000
N/A
—
Enumeration date
01/19/2020
Last updated
05/19/2020
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