Individual
ANTHONY TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5704 SWEETWATER DR, SHREVEPORT, LA 71119-4018
(318) 402-2418
Mailing address
5704 SWEETWATER DR, SHREVEPORT, LA 71119-4018
(318) 402-2418
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/20/2021
Last updated
03/16/2023
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