Tidball, Eleanor Arlene
Tidball, Eleanor Arlene is an sole proprietor health care provider with primary practice located at 13320 W Grange Ave , New Berlin WI 53151-8131. She recently has only one registered license in Behavioral Health & Social Service Providers / Counseling, which is considered as her primary health care specialty. Tidball, Eleanor Arlene can be contacted via phone (414) 467-3780.Contact Information
Primary practice address
13320 W Grange Ave
New Berlin WI 53151-8131
Phone: (414) 467-3780
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counseling | 103TC1900X | 4590-226 | Wisconsin |
Profile Details
| NPI number | 1629607619 |
|---|---|
| LBN Legal business name | Tidball, Eleanor Arlene |
| Credentials | LPC-IT |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 2nd, 2020 |
| Last updated | Apr 2nd, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629607619 | NPPES |
| Wisconsin | MEDICAID | 19943852 |
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