Individual
BESSIE ELIZABETH TADLOCK-JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
BP00943450
WV
104100000X
Social Worker
BP00943450
WV
1041C0700X
Clinical Social Worker
Primary
DP00943450
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023815000
—
WV
Enumeration date
07/15/2013
Last updated
04/06/2022
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