Provider Demographics
NPI:1346017209
Name:TIDWELL, DARBI (MA, INTERN)
Entity Type:Individual
Prefix:
First Name:DARBI
Middle Name:
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:MA, INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6371 SAFE HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-1043
Mailing Address - Country:US
Mailing Address - Phone:325-200-5744
Mailing Address - Fax:
Practice Address - Street 1:4300 COUNTY ROAD 557 LN
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-0918
Practice Address - Country:US
Practice Address - Phone:325-200-5744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health