Active NPI
Lorisa Dawn Tidwell, LCSW
- Clinical Social Worker
- Oklahoma City, OK
National Provider Identifier
1609213446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4407
- Practice address
- 2632 Lynn LN
Oklahoma City, OK 73120-1702 - Phone
- (402) 366-8796
- NPI assigned
- Jun 3, 2013
- Sex
- Female
- 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 | 4407 | OK | Primary |
Addresses
Primary practice location
2632 Lynn LN
Oklahoma City, OK 73120-1702
Mailing address
247 Cumberland LN
Ardmore, OK 73401-7568
Phone (405) 693-6061
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4407 | OK | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428537600000",
"number": "1609213446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "247 CUMBERLAND LN",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734017568",
"telephone_number": "405-693-6061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2632 LYNN LN",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731201702",
"telephone_number": "402-366-8796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDWELL",
"first_name": "LORISA",
"middle_name": "DAWN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-03",
"last_updated": "2015-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OK",
"license": "4407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.