Provider Demographics
NPI:1558658765
Name:TIDWELL, KAREN SUE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7201
Mailing Address - Country:US
Mailing Address - Phone:941-926-2959
Mailing Address - Fax:
Practice Address - Street 1:3224 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7201
Practice Address - Country:US
Practice Address - Phone:941-926-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health