Alicia Ellen Tisdale, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301003007 Issued in MI

Practice address

5101 Willow Pond Drive
West Bloomfield, MI 48323

Phone

(248) 974-1783

NPI assigned

Aug 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Thomas Park M.D. PC

  • Preferred Provider Organization
  • Southfield, MI
  • NPI 1881904605
  Medicare reassignment NPD
• A Better Tomorrow Counseling and Consultation Services, LLC

  • Mental Health Counselor
  • Redford, MI
  • NPI 1962763052
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1083622914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 WILLOW POND DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232094",
            "telephone_number": "248-706-1453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 WILLOW POND DRIVE",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "48323",
            "telephone_number": "248-974-1783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "ALICIA",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301003007",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301003007",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prasad J Thottam, D.O.
• Judith Linda Thurswell, PSYD
• Alaina Thweni
• Esther Marie Tillman, CRNA
• Ann Timm, RN
• TJ Cares LLC
• TMS Wellness Clinic of Michigan PLLC
• Todays Life Choices, LLC
• Yousif Tokatly, OD
• Kelli Tomic, M.A., CCC/SLP

• Psychologist in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.