Individual
ELEANOR ARLENE TIDBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
13320 W GRANGE AVE, NEW BERLIN, WI 53151-8131
(414) 467-3780
Mailing address
13320 W GRANGE AVE, NEW BERLIN, WI 53151-8131
(414) 467-3780
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
4590-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19943852
—
WI
Enumeration date
04/02/2020
Last updated
04/02/2020
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