Elysia N Tidey
NPI #1104541242 in South Bend, Indiana
Provider Information
- NPI Number
- 1104541242
- Entity Type
- Individual
- Name
- Elysia N Tidey
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor
- Enumeration Date
- Oct 11, 2022
- Last Updated
- Oct 11, 2022
Practice Location
- Address
- 611 LINCOLN WAY E
- City
- South Bend
- State
- Indiana
- ZIP Code
- 46601-3212
- Phone
- (574) 360-4066
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor |
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