Eleanor Arlene Tidball, LPC-IT

NPI #1629607619 in New Berlin, Wisconsin

Provider Information

NPI Number: 1629607619
Entity Type: Individual
Name: Eleanor Arlene Tidball, LPC-IT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - Counseling
Credential: LPC-IT
Enumeration Date: Apr 2, 2020
Last Updated: Apr 2, 2020

Practice Location

Address: 13320 W GRANGE AVE
City: New Berlin
State: Wisconsin
ZIP Code: 53151-8131
Phone: (414) 467-3780

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Counseling — Counseling	103TC1900X	Primary

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