Provider Demographics
NPI:1861793085
Name:TIDYMAN, MARY M (PLMHP, LADC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:TIDYMAN
Suffix:
Gender:F
Credentials:PLMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N BAILEY
Mailing Address - Street 2:P.O. BOX 1208
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-1208
Mailing Address - Country:US
Mailing Address - Phone:308-534-6029
Mailing Address - Fax:308-534-6961
Practice Address - Street 1:110 N BAILEY
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101
Practice Address - Country:US
Practice Address - Phone:308-534-6029
Practice Address - Fax:308-534-6961
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1280101YA0400X
NE14180101YM0800X
NE12069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)