Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Medical |
363AM0700X | 97 | Physician Assistant | |
Adolescent and Children Mental Health |
261QM0855X | |||
Mental Health (Including Community Mental Health Center) |
261QM0801X | B4[14] | Community Mental Health Center | |
Primary Care |
261QP2300X |
| NPI Number | 1679156004 |
| LBN Legal business name | RED TYDE |
| Authorized official | TIFFANY REDMOND - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 05/03/2021 |
| Last updated | 04/20/2026 - About 2 months ago |
| Identifiers | n/a |
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