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Kenneth Tisdale, L.C.I.C.I., LMT #548
NPI 1962709956 · on the registry since 2011 · sole proprietor
Practice
- Address
- 201 Eubank Blvd Ne
B1
Albuquerque, NM 87123 - Phone
- (505) 712-7585
- Organisation at this address
- Ariadnes Thread Llc
Davidson Therapeutic Solutions LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 4
Registry record
- Primary taxonomy
- Contractor
171W00000X
- Licence states on file
- NM
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2011-02-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New Mexico