Provider Demographics
NPI:1972847093
Name:TIDWELL, JENAI (LPC-S)
Entity type:Individual
Prefix:
First Name:JENAI
Middle Name:
Last Name:TIDWELL
Suffix:
Gender:
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 WOODWAY DR STE 585
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1529
Mailing Address - Country:US
Mailing Address - Phone:832-831-8379
Mailing Address - Fax:
Practice Address - Street 1:7660 WOODWAY DR STE 585
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1529
Practice Address - Country:US
Practice Address - Phone:832-831-8379
Practice Address - Fax:832-831-8388
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69448101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health