Active NPI
Kristina Joan Tidwell, APCC
- Mental Health Counselor
- Makawao, HI
National Provider Identifier
1609647627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 200 Ike Dr
Makawao, HI 96768-9718 - Phone
- (808) 316-9600
- NPI assigned
- Jan 9, 2024
- Last updated
- May 29, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 14095 | CA | |
| Mental Health Counselor | 101YM0800X | HI | Primary |
Addresses
Primary practice location
200 Ike Dr
Makawao, HI 96768-9718
Mailing address
70 Central Ave Ste 6
Wailuku, HI 96793-1701
Phone (909) 708-5106
Other practice location 1
41680 Ivy St Ste D
Murrieta, CA 92562-9435
Phone (619) 549-0329 ext. 724
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14095 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Through Life Counseling, Inc. | Mental Health | Current | Accepting new patients |
Locations
41680 Ivy St
Ste D
Murrieta, CA 92562
Phone (614) 549-0329
Organizations & group practices 1
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.
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- San Diego, CA
- NPI 1801385745
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748476800000",
"number": "1609647627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 CENTRAL AVE STE 6",
"city": "WAILUKU",
"state": "HI",
"postal_code": "967931701",
"telephone_number": "909-708-5106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 IKE DR",
"city": "MAKAWAO",
"state": "HI",
"postal_code": "967689718",
"telephone_number": "808-316-9600"
}
],
"practiceLocations": [
{
"address_1": "41680 Ivy St Ste D",
"address_purpose": "LOCATION",
"city": "Murrieta",
"state": "CA",
"postal_code": "925629435",
"country_code": "US",
"telephone_number": "619-549-0329 x724",
"fax_number": "619-550-3547",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TIDWELL",
"first_name": "KRISTINA",
"middle_name": "JOAN",
"name_prefix": "Ms.",
"credential": "APCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-09",
"last_updated": "2025-05-29",
"certification_date": "2025-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "14095",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "HI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Makawao, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.