| Tidwell Social Work Services And Consulting, Inc. | |
|
5999 W State St Boise ID 83703-5059 | |
| (208) 853-5095 | |
| (208) 853-5125 |
| Full Name | Tidwell Social Work Services And Consulting, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 5999 W State St, Boise, Idaho |
| Authorized Official Name and Position | Kathy M. Tidwell (PRESIDENT) |
| Authorized Official Contact | 2088535095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidwell Social Work Services And Consulting, Inc. 5999 W State St Boise ID 83703-5059 Ph: (208) 853-5095 | Tidwell Social Work Services And Consulting, Inc. 5999 W State St Boise ID 83703-5059 Ph: (208) 853-5095 |
| NPI Number | 1760891063 |
|---|---|
| Provider Enumeration Date | 08/12/2014 |
| Last Update Date | 08/12/2014 |
| Medicare PECOS PAC ID | 2163643511 |
|---|---|
| Medicare Enrollment ID | O20141028001480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760891063 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Idaho) | Secondary |
| 1041C0700X | Social Worker - Clinical | (Idaho) | Primary |
| Provider Name | Kimi J Eames |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427333673 PECOS PAC ID: 3870747843 Enrollment ID: I20130129000553 |
| Provider Name | Courtney Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043854599 PECOS PAC ID: 5092195578 Enrollment ID: I20220629003505 |
| Provider Name | Benjamin Wenetzky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023561990 PECOS PAC ID: 6901286483 Enrollment ID: I20220629003507 |
| Provider Name | Melissa L Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386767333 PECOS PAC ID: 5799165288 Enrollment ID: I20220629003618 |
| Provider Name | Ramatoulie M Deen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437435948 PECOS PAC ID: 5799906145 Enrollment ID: I20220728000322 |
| Provider Name | Matthew Hallowell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124526249 PECOS PAC ID: 8426434366 Enrollment ID: I20220930000241 |
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