Individual
MR. BRUCE BERNARD TISDALE
Active
Individual
MR. BRUCE BERNARD TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DSW, LICSW, LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LC50078990
DC
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
G11619
MD
1041C0700X
Clinical Social Worker
LC50078990
MD
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Enumeration date
10/22/2008
Last updated
01/17/2024
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