Tidwell Social Work Services and Consulting, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC-6143 Issued in ID

Legal business name

TIDWELL SOCIAL WORK SERVICES AND CONSULTING, INC.

Practice address

5999 W. State St.
Boise, ID 83703

Phone

(208) 853-5095

Fax

(208) 853-5125

NPI assigned

Jun 3, 2016

Organization subpart

No

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

Authorized official

Name

Kathy Matlock Tidwell, LCSW

Title

Clinic Supervisor

Phone

(208) 853-6649

Specialties & licenses 1

Addresses

Other names 1

• Tidwell Social Work Services and Consulting Other name

Locations

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568592000000",
    "number": "1124476858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7285 W FRANKLIN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837090926",
            "telephone_number": "208-853-5095",
            "fax_number": "208-853-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5999 W. STATE ST.",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83703",
            "telephone_number": "208-853-5095",
            "fax_number": "208-853-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDWELL SOCIAL WORK SERVICES AND CONSULTING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-03",
        "last_updated": "2019-09-16",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "MATLOCK",
        "authorized_official_title_or_position": "CLINIC SUPERVISOR",
        "authorized_official_telephone_number": "208-853-6649",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ID",
            "license": "LPC-6143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidwell Social Work Services and Consulting",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nicole L Thurston, MD
• Sara Thurston, AUD
• Jeremiah Lee Tibbitts, DC
• Brook Rose Tiddens, CNM
• Tides Treatment Services
• Tidwell Social Work Services and Consulting, Inc.
• Kathy Matlock Tidwell, LCSW
• Kathleen Tierney, NP
• Quinn Tierney, LCSW
• Shannon Marie Tierney, MD

• Community/Behavioral Health Agency in Boise, ID
• Providers in Boise, ID by specialty
• Community/Behavioral Health Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.

Verify at the official NPI Registry.