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DR. THERESA CLEMENT TISDALE PH.D.
NPI 1629316682
Psychologist - Clinical in Glendora, CA

Active since January 26, 2013Opted out of Medicare · through Aug 22, 2026
150 E MEDA AVE, SUITE 110, GLENDORA, CA 91741(626) 224-5204 Get Directions Write a Review

NPPES record last updated: January 26, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Theresa Clement Tisdale Ph.d. NPPES

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

DR. THERESA CLEMENT TISDALE PH.D. (NPI 1629316682) is an individual clinical provider in Glendora, California, licensed in California (18587) and active in the NPI registry since January 2013. She has opted out of Medicare through August 22, 2026.

NPPES Registry Identity

NPI1629316682
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. THERESA CLEMENT TISDALECredential: PH.D.
Location Address150 E MEDA AVE, SUITE 110Glendora, CA 91741-2689
Mailing Address150 E Meda Ave, Suite 110Glendora, CA 91741-2689 · (626) 224-5204
Phone(626) 224-5204
Sole ProprietorYes
Enumeration DateJanuary 26, 2013
✔ NPI 1629316682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in CA · 18587
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
Also ListedPsychologistTaxonomy 103T00000X · License 18587 (CA)
150 E MEDA AVE, Glendora, CA 91741
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Theresa Clement Tisdale Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from August 22, 2022 through August 22, 2026.

Opt-Out Effective DateAugust 22, 2022
Opt-Out In Effect ThroughAugust 22, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. MADRID V. JACOBS-BROWN M.A., MFT
Marriage & Family Therapist
150 E MEDA AVE
GLENDORA, CA 91741
Los Angeles County (626) 676-6176
RICHARD FOSS PH.D.
Psychologist (Clinical)
150 E MEDA AVE, SUITE 110
GLENDORA, CA 91741
Los Angeles County (626) 351-9616
DR. LISA M IRWIN
Psychologist (Clinical)
150 E MEDA AVE, STE. 270
GLENDORA, CA 91741
Los Angeles County (626) 806-4617
MRS. GLENDA LEE REID LCSW
Social Worker (Clinical)
150 E MEDA AVE, SUITE 110
GLENDORA, CA 91741
Los Angeles County (626) 705-2540
KIMBERLY MOYER
Counselor (Mental Health)
150 E MEDA AVE
GLENDORA, CA 91741
Los Angeles County (909) 782-7578

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 Theresa Tisdale's NPI number?

The NPI number for Theresa Tisdale is 1629316682. It was assigned to this individual provider in the NPPES registry on January 26, 2013.

Where is Theresa Tisdale located?

Theresa Tisdale practices at 150 E Meda Ave Suite 110, Glendora, CA 91741. The listed phone number is (626) 224-5204.

What is Theresa Tisdale's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Theresa Tisdale enrolled in Medicare?

No. Theresa Tisdale has opted out of Medicare through August 22, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Theresa Tisdale was last updated on January 26, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.