DR. ALICIA ELLEN TISDALE PHD
NPI 1083622914
Psychologist in West Bloomfield, MI

Active since August 04, 2006PECOS EnrolledAccepts Medicare Assignment
5101 WILLOW POND DRIVE, WEST BLOOMFIELD, MI 48323(248) 974-1783 Get Directions Write a Review

NPPES record last updated: October 30, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Alicia Ellen Tisdale Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ALICIA ELLEN TISDALE PHD (NPI 1083622914) is an individual psychologist in West Bloomfield, Michigan, licensed in Michigan (6301003007) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS and is a graduate of Other (1988).

NPPES Registry Identity

NPI1083622914
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. ALICIA ELLEN TISDALECredential: PHD
Location Address5101 WILLOW POND DRIVEWest Bloomfield, MI 48323
Mailing Address5101 Willow Pond DrWest Bloomfield, MI 48323-2094 · (248) 706-1453
Sole ProprietorNo
Medical School CMSOtherGraduated 1988
Enumeration DateAugust 4, 2006
Last NPPES UpdateOctober 30, 2025
NPPES CertifiedOctober 30, 2025
NPI 1083622914 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in MI · 6301003007
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 6301003007 (MI)
5101 WILLOW POND DRIVE, West Bloomfield, MI 48323

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Alicia Ellen Tisdale Phd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6800926585
PECOS Enrollment IDI20100607000096
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Alicia Tisdale's NPI number?

The NPI number for Alicia Tisdale is 1083622914. It was assigned to this individual provider in the NPPES registry on August 4, 2006.

Where is Alicia Tisdale located?

Alicia Tisdale practices at 5101 Willow Pond Drive, West Bloomfield, MI 48323. The listed phone number is (248) 974-1783.

What is Alicia Tisdale's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Alicia Tisdale enrolled in Medicare?

Yes. Alicia Tisdale is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Alicia Tisdale was last updated on October 30, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.