NPIMap

Organization Active NPI

Kathy Matlock Tidwell

Doing business as Tidwell Social Work Services & Consulting

  • Clinical Social Worker
  • Boise, ID
National Provider Identifier
1669401311
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
KATHY MATLOCK TIDWELL
Doing business as
Tidwell Social Work Services & Consulting
Practice address
5999 W State St
Boise, ID 83703-5059
Phone
(208) 853-5095
Fax
(208) 853-5125
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

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

Authorized official

Name
Ms. Kathy Tidwell, LCSW
Title
Owner
Phone
(208) 853-5095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

5999 W State St
Boise, ID 83703-5059

Mailing address

5999 W State St
Boise, ID 83703-5059
Phone (208) 853-5095

Other identifiers 1

IdentifierTypeStateIssuer
806014000MedicaidID

Other names 1

  • Tidwell Social Work Services & Consulting Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1669401311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5999 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035059",
            "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": "837035059",
            "telephone_number": "208-853-5095",
            "fax_number": "208-853-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHY MATLOCK TIDWELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-853-5095",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806014000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidwell Social Work Services & Consulting",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; 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.