Provider Demographics
NPI:1881052694
Name:TINDALL, CURTIS
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:TINDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 1ST ST STE 160
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5246
Mailing Address - Country:US
Mailing Address - Phone:608-225-4002
Mailing Address - Fax:608-255-2752
Practice Address - Street 1:111 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5244
Practice Address - Country:US
Practice Address - Phone:608-225-4002
Practice Address - Fax:608-255-2752
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WI7614-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)