Olivia Tidwell

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

89364 Issued in TX

Practice address

1617 Park Place Ave Ste 110
Fort Worth, TX 76110-1300

Phone

(940) 226-1711

NPI assigned

Oct 28, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Well Counseling Group

  • Professional Counselor
  • Fort Worth, TX
  • NPI 1699646091
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1073220257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 PARK PLACE AVE STE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761101300",
            "telephone_number": "940-226-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 PARK PLACE AVE STE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761101300",
            "telephone_number": "940-226-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "OLIVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-28",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "89364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Shay Tice, ACNP
• Christi Tice, LCDC
• Tristin Tice
• Rachael Ticer, MS
• Heath William Hall Tidwell
• Jana Tieding, CCC-SLP
• Shelby Rigdon Tieken, AGACNP-BC
• Kevin Wells Tien, MD
• Tate Lundy Tieperman, PT, DPT
• Millard Lucien Tierce IV, D.O.

• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.