Stephanie Sherelle Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

58542 Issued in TX

Practice address

5515 Devils Gate Unit 2
Converse, TX 78109-2671

Phone

(832) 362-2591

NPI assigned

Jan 23, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Senior Psychological Care Sa I, LLC

  • Psychologist
  • Houston, TX
  • NPI 1205122355

  Clinical, TX

  Medicare reassignment NPD
• Teatalkstherapy, PLLC

  • Adult Mental Health Clinic/Center
  • Bulverde, TX
  • NPI 1114624079

  TX

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1003521139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5515 DEVILS GATE UNIT 2",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "781092671",
            "telephone_number": "832-362-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5515 DEVILS GATE UNIT 2",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "781092671",
            "telephone_number": "832-362-2591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHANIE",
        "middle_name": "SHERELLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-23",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "58542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Hyde, BCBA
• Caleb J Ibarra
• Angele Iglehart
• Internal Healing Center
• Claire Jackson
• Jodi Flanagan O.D. P.a.
• Christopher Lee Johnson, BCBA
• Deja Johnson
• Bosyonpletooth A Joiner
• Tuwani Jones

• All providers in Converse, TX
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.