LISA D TIDWELL-MCKAY (NPI# 1629375761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629375761 |
| Entity Type | Individual |
| Full Name | LISA D TIDWELL-MCKAY |
| Credential | MS, CADC, LPC-S |
| Practice Address |
19600 E Ross St Tahlequah OK 74464-0545 |
| Mailing Address |
6810 S. 55th St. E. Muskogee OK 74403 |
| Practice Telephone | 5392343555 |
| Practice Fax Number | 5392343501 |
| Mailing Telephone | 9183106279 |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2020-09-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
412 | OK | Behavioral Health & Social Service Providers |
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
5739 | OK | Behavioral Health & Social Service Providers |
| Street Address |
19600 E ROSS ST |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-0545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083670566 | Shawn Scarberry Miller | Family Medicine | 19600 E Ross St, Tahlequah, OK 74464-0545 | 2006-04-25 |
| 1528671237 | Madeleine Moss Perry | Pharmacist | 19600 E Ross St, Tahlequah, OK 74464-0545 | 2020-08-24 |
| 1700496973 | Angela J Fitch | Pharmacist | 19600 E Ross St, Tahlequah, OK 74464-0545 | 2020-08-03 |
| 1992052674 | Emily Wauneka Berg Ikahihifo | Dentist | 19600 E Ross St, Tahlequah, OK 74464-0545 | 2012-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558919209 | Gladys Paola Guthrie | Counselor | 1205 S Ross Ave, Tahlequah, OK 74464-7323 | 2019-08-27 |
| 1568931558 | Ashley N Canoe | Counselor | 1332 E Allen Rd Apt 4, Tahlequah, OK 74464-2250 | 2018-11-19 |
| 1437625654 | Oklahoma United Methodist Circle of Care | Counselor | 549 Mathis Park Dr, Tahlequah, OK 74464-6820 | 2018-10-15 |
| 1528511508 | Chana Watts | Counselor | 1312 Jackson Ave, Tahlequah, OK 74464-6624 | 2016-07-26 |
| 1376954438 | Deboraugh De Ann Allen | Counselor | 24332 E 757 Rd, Tahlequah, OK 74464-1949 | 2014-05-12 |
| 1295157774 | Blake Lundry | Counselor | 3475 Southridge Pl, Unit 7, Tahlequah, OK 74464-7912 | 2014-01-17 |
| 1598194656 | Lois Fuller | Counselor | 14857 N Tyler St, Tahlequah, OK 74464-1078 | 2013-11-08 |
| 1821427295 | Brenda Joe Teehee | Counselor | 25719 S Pin Oak Dr, Tahlequah, OK 74464-1473 | 2013-11-06 |
| 1023355591 | Chad Alvin Harp | Counselor | 505 Talley St, Tahlequah, OK 74464-6335 | 2013-01-03 |
| 1316283245 | Jim Lee Trammell | Counselor | 113 W. Shawnee St, Tahlequah, OK 74464 | 2012-12-20 |
| Find all providers in TAHLEQUAH | ||||
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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.