Stewart Gregory Tidwell, MA, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39001806A Issued in IN

Practice address

2525 Lake Ave
Fort Wayne, IN 46805-5407

Phone

(260) 484-4153

NPI assigned

Jul 22, 2009

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248220800000",
    "number": "1992935142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055407",
            "telephone_number": "260-484-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055407",
            "telephone_number": "260-484-4153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "STEWART",
        "middle_name": "GREGORY",
        "name_prefix": "Mr.",
        "credential": "MA, LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-22",
        "last_updated": "2009-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39001806A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Thurber
• Amanda Thurston, MS, RD, CD, CDE
• Corey Tibbs
• Melinda Tiburcio
• Sonya Tichler, PTA
• Jonathan Alvin Tiedeman, SCHOOL PSYCHOLOGIST
• Susan Marie Tielker-Sharpe, LCSW LMFT ACSW
• Richard Elmer Tielker, M.D.
• Kelsey E. Tiernon, MA
• Paige Tiernon

• Mental Health Counselor in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; 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.