Active NPI
Eric Tidline
- Clinical Social Worker
- Houston, TX
National Provider Identifier
1083261663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 26747
- Practice address
- 3007 Caroline St
Houston, TX 77004-2822 - Phone
- (713) 528-2328
- NPI assigned
- Aug 20, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 26747 | TX | Primary |
Addresses
Primary practice location
3007 Caroline St
Houston, TX 77004-2822
Mailing address
5631 Drakestone Blvd
Houston, TX 77053-2010
Phone (713) 434-1353
Other practice location 1
5631 Drakestone Blvd
Houston, TX 77053-2010
Phone (713) 434-1353
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566259200000",
"number": "1083261663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5631 DRAKESTONE BLVD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770532010",
"telephone_number": "713-434-1353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3007 CAROLINE ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770042822",
"telephone_number": "713-528-2328"
}
],
"practiceLocations": [
{
"address_1": "5631 Drakestone Blvd",
"address_purpose": "LOCATION",
"city": "Houston",
"state": "TX",
"postal_code": "770532010",
"country_code": "US",
"telephone_number": "713-434-1353",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TIDLINE",
"first_name": "ERIC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-20",
"last_updated": "2019-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "26747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.