Tidwell, Stacey

Tidwell, Stacey is an individual health care provider with primary practice located at 3311 Morada Ln , Stockton CA 95212-3148. She recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as her primary health care specialty. Tidwell, Stacey can be contacted via phone (209) 647-3047.

Contact Information

Primary practice address
3311 Morada Ln Stockton CA 95212-3148
Phone: (209) 647-3047
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 1041S0200X

Profile Details

NPI number 1790189413
LBN Legal business name Tidwell, Stacey
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 9th, 2014
Last updated Dec 30th, 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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