Michael Tidstrand, BA, MA, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPCC7019 Issued in CA

Practice address

20112 Runnymede St Unit 5
Winnetka, CA 91306-2901

Phone

(818) 216-0321

NPI assigned

Jan 19, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts, Master of Arts

State licenses

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

{
    "created_epoch": "1579392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1548890544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20112 RUNNYMEDE ST UNIT 5",
            "city": "WINNETKA",
            "state": "CA",
            "postal_code": "913062901",
            "telephone_number": "818-216-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20112 RUNNYMEDE ST UNIT 5",
            "city": "WINNETKA",
            "state": "CA",
            "postal_code": "913062901",
            "telephone_number": "818-216-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDSTRAND",
        "first_name": "MICHAEL",
        "credential": "BA, MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-19",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "LPCC7019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "000",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fmbtagency.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "5530 Corbin Ave Ste 221",
            "city": "Tarzana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913566095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sunray Hospice Inc
• Kelley Michelle Tapia, LMFT
• The Winners Edge:Physical Therapy,Sports Performance, Consulting Inc
• Poppy Widyastuti The, DDS
• Sarah Alexis Thomason
• Joshua Daquiz Tolentino
• Roza Tonoyan
• Sharon K. Tso, D.D.S.
• David Tucker, LMFT
• Carol M Tyree, MA, AMFT

• Professional Counselor in Winnetka, CA
• Providers in Winnetka, CA by specialty
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; 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.