MARY TIDWELL (NPI# 1407473234) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407473234 |
| Entity Type | Individual |
| Full Name | MARY TIDWELL |
| Credential | LPC-C |
| Practice Address |
525 Liberty Ln Edmond OK 73034-9046 |
| Mailing Address |
1109 Ne 16th St Oklahoma City OK 73117-1015 |
| Practice Telephone | 4057268966 |
| Mailing Telephone | 9186914521 |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2020-07-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
525 LIBERTY LN |
| City | EDMOND |
| State | OK |
| Zip Code | 73034-9046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083215586 | Nercissa E Newberry | Counselor | 525 Liberty Ln, Edmond, OK 73034-9046 | 2020-11-03 |
| 1477151355 | Andreae N Mcginnis | Counselor | 525 Liberty Ln, Edmond, OK 73034-9046 | 2020-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447172 | Saints Medical Group, LLC | Family Medicine | 2749 Progressive Dr, Suite B, Edmond, OK 73034 | 2020-11-06 |
| 1194339861 | Susan Haesook Kim | Pharmacist | 1400 2nd St, Edmod, Edmond, OK 73034 | 2020-09-01 |
| 1821616038 | Aaron Michael Gowens | Specialist/Technologist | 015 Wantland Hall 100 University Dr., Edmond, OK 73034 | 2020-07-14 |
| 1043834849 | Paddington Place Lcc | Intermediate Care Facility, Mental Illness | 3225 French Park Drive, Suite 6, Edmond, OK 73034 | 2020-06-08 |
| 1083254932 | Purpose Healthcare Inc | Psychologist | 301 South Blvd, Suite 117, Edmond, OK 73034 | 2020-01-08 |
| 1740773662 | Healthcare Express, LLP | Family Medicine | 2300 E 2nd St, Edmond, OK 73034 | 2018-06-14 |
| 1427555713 | Sara Nicole Smith | Specialist/Technologist | 100 N University Drive, Attn: Athletic Training Room, Edmond, OK 73034 | 2018-04-12 |
| 1619475084 | Carissa Leigh Brackelsberg | Chiropractor | 3709 E 2nd St, Edmond, OK 73034 | 2018-01-31 |
| 1760996177 | Laurel Michelle Glendening | Physical Therapist | 3531 River Wood Lane, Edmond, OK 73034 | 2017-11-21 |
| 1134643380 | Keith S Quinn | Dentist | 3008 Peaceful Ln, Edmond, OK 73034 | 2017-07-31 |
| Find all providers in zip 73034 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962013912 | Ashley Lambert | Counselor | 19501 N Pennsylvia, Apt 210, Edmond, OK 73012 | 2020-08-13 |
| 1467070565 | Kelsey Hines | Counselor | 2000 E 15th St Ste 450c, Edmond, OK 73013-6670 | 2020-07-06 |
| 1063039568 | Amber Nicole Aranda | Counselor | 2501 Glen Hollow Rd, Edmond, OK 73034-4279 | 2020-06-30 |
| 1326676610 | Melissa Mendez | Counselor | 2716 Nw 189th St, Edmond, OK 73012-0015 | 2020-03-31 |
| 1407490048 | Leslie Burnside | Counselor | 600 N Blackwelder Ave Apt 24, Edmond, OK 73034-5167 | 2019-11-06 |
| 1033689203 | Charles Watson Robinson IIi | Counselor | 1401 Nw 150th St Ste B, Edmond, OK 73013-2169 | 2018-11-30 |
| 1801362983 | Ida Moore | Counselor | 16224 Everglade Ln, Edmond, OK 73013-1259 | 2018-10-16 |
| 1538662952 | Josiah Stogsdill | Counselor | 307 E Danforth Rd Ste 124, Edmond, OK 73034-4484 | 2018-03-12 |
| 1356861538 | Mackenzie O'mealey | Counselor | 425 S Fretz Ave Ste C, Edmond, OK 73003-5568 | 2017-06-20 |
| 1437685377 | Ambra Gales | Counselor | 16204 Windrush Pl, Edmond, OK 73013-9418 | 2017-05-11 |
| Find all providers in EDMOND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.