Emily Jane Tisdale, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-33094 Issued in AL

Practice address

1203 US Highway 98 Ste 2A9
Daphne, AL 36526

Phone

(314) 920-1828

Fax

(251) 243-0984

NPI assigned

Dec 4, 2017

Last updated

Aug 19, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Emily Jane Meyer Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• With Great Love, LLC

  • Community/Behavioral Health Agency
  • Daphne, AL
  • NPI 1033779608
  NPD Authorized official

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1366957011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 US HIGHWAY 98 STE 2A9",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365263901",
            "telephone_number": "314-920-1828",
            "fax_number": "251-243-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 US HIGHWAY 98 STE 2A9",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "36526",
            "telephone_number": "314-920-1828",
            "fax_number": "251-243-0984"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5465 Able Ct",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366933100",
            "country_code": "US",
            "telephone_number": "251-649-4420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "EMILY",
        "middle_name": "JANE",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-04",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "AL",
            "license": "0-14-6203",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "AL",
            "license": "1-18-33094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Neocertified",
            "affiliation": "N",
            "endpointDescription": "Neocertified",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1203 US Highway 98 Ste 2A9",
            "city": "Daphne",
            "state": "AL",
            "country_code": "US",
            "postal_code": "365263901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "MEYER",
            "middle_name": "JANE",
            "credential": "BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• John Jay Thurman, LICSW
• Kayla Tibbs
• John Lee Todd, M.D.
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• Kellie S. Toth, PHYSICIAN ASSISTANT
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• Behavior Analyst in Daphne, AL
• Providers in Daphne, AL by specialty
• Behavior Analyst in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.