Individual
MR. MICHAEL A TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP00003857
Contact information
Practice address
308 E. YOUNG ST., ELMA, WA 98541
(360) 482-2674
Mailing address
PO BOX 477, ELMA, WA 98541-0477
(360) 482-2674
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00003857
WA
Other
Enumeration date
04/05/2010
Last updated
04/05/2010
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