Tidwell, Benjamin L

Tidwell, Benjamin L is an individual health care provider with primary practice located at 5905 Us 301 S , Riverview FL 33578-3800. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Tidwell, Benjamin L can be contacted via phone (866) 389-2727.

Contact Information

Primary practice address
5905 Us 301 S Riverview FL 33578-3800
Phone: (866) 389-2727
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1283C Arkansas

Profile Details

NPI number 1861407520
LBN Legal business name Tidwell, Benjamin L
Credentials LCSW, CCDP-DIPLOMATE
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 30th, 2006
Last updated Aug 11th, 2021 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861407520 NPPES
Arkansas MEDICAID 175962795

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