Timothy Michael Tisdell, PSYD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PSY19828 Issued in CA

Practice address

1250 Grand Ave
Piedmont, CA 94610-1002

Phone

(510) 655-7880

Fax

(510) 655-3379

NPI assigned

Jun 27, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Ann Martin Center

  • Community/Behavioral Health Agency
  • Oakland, CA
  • NPI 1952613812
  NPD (past)

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750588406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 GRAND AVE",
            "city": "PIEDMONT",
            "state": "CA",
            "postal_code": "946101002",
            "telephone_number": "510-655-7880",
            "fax_number": "510-655-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 GRAND AVE",
            "city": "PIEDMONT",
            "state": "CA",
            "postal_code": "946101002",
            "telephone_number": "510-655-7880",
            "fax_number": "510-655-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDELL",
        "first_name": "TIMOTHY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "PSY19828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Stark
• Brittany Steiminger
• Colleen Stormer, MSW
• Kirby Gilbert Surprise, PSYD
• Geordan Thurston
• Julie Tran
• Shufang Tsai, PSYD
• Katrina Unpingco, FNP-C
• Vicky Valverde-Salas, M.D.
• Karen Van Leuven, PHD, FNP

• Mental Health Counselor in Piedmont, CA
• Providers in Piedmont, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.