Provider Demographics
NPI:1972847093
Name:TIDWELL, JENAI (LPC)
Entity Type:Individual
Prefix:
First Name:JENAI
Middle Name:
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 SNAKE RIVER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7750
Mailing Address - Country:US
Mailing Address - Phone:281-394-1379
Mailing Address - Fax:
Practice Address - Street 1:1826 SNAKE RIVER RD
Practice Address - Street 2:SUITE D
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7750
Practice Address - Country:US
Practice Address - Phone:281-394-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69448101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health