Individual
LISA D TIDWELL-MCKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CADC, LPC-S
Contact information
Practice address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-3555
(539) 234-3501
Mailing address
6810 S. 55TH ST. E., MUSKOGEE, OK 74403
(918) 310-6279
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
412
OK
101YM0800X
Mental Health Counselor
Primary
5739
OK
Other
Enumeration date
02/25/2011
Last updated
04/20/2021
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