Individual
LORISA DAWN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2632 LYNN LN, OKLAHOMA CITY, OK 73120-1702
(402) 366-8796
Mailing address
247 CUMBERLAND LN, ARDMORE, OK 73401-7568
(405) 693-6061
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4407
OK
Other
Enumeration date
06/03/2013
Last updated
04/09/2015
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