Individual
MR. GLEN EDWARD TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4235 VALLEYFIELD ST, SAN ANTONIO, TX 78222-3714
(210) 709-5848
Mailing address
4235 VALLEYFIELD ST, SAN ANTONIO, TX 78222-3714
(210) 709-5848
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
73414
TX
101YM0800X
Mental Health Counselor
Primary
73414
TX
101YP2500X
Professional Counselor
73414
TX
Other
Enumeration date
10/28/2016
Last updated
09/12/2024
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