Provider Demographics
NPI:1194573915
Name:TIDWELL, TANYANIKA A (LMSW)
Entity type:Individual
Prefix:MS
First Name:TANYANIKA
Middle Name:A
Last Name:TIDWELL
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 KINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3801
Mailing Address - Country:US
Mailing Address - Phone:281-312-8469
Mailing Address - Fax:
Practice Address - Street 1:20000 KINGWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3801
Practice Address - Country:US
Practice Address - Phone:281-312-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108779104100000X
WA108779104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker