Active NPI
Jeanette Rene Holland, LCSW
- Clinical Social Worker
- Mansfield, TX
National Provider Identifier
1275194565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 57183
- Practice address
- 2804 Matlock Rd
Mansfield, TX 76063-5003 - Phone
- (817) 821-5203
- NPI assigned
- Jun 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 57183 | TX | Primary |
Addresses
Primary practice location
2804 Matlock Rd
Mansfield, TX 76063-5003
Mailing address
PO Box 2603
Fort Worth, TX 76113-2603
Phone (817) 569-4039
Other practice location 1
3840 Hulen St
Fort Worth, TX 76107-7277
Phone (817) 335-3022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57183 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568332800000",
"number": "1275194565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2603",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761132603",
"telephone_number": "817-569-4039",
"fax_number": "817-810-3042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2804 MATLOCK RD",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760635003",
"telephone_number": "817-821-5203"
}
],
"practiceLocations": [
{
"address_1": "3840 Hulen St",
"address_purpose": "LOCATION",
"city": "Fort Worth",
"state": "TX",
"postal_code": "761077277",
"country_code": "US",
"telephone_number": "817-335-3022",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HOLLAND",
"first_name": "JEANETTE",
"middle_name": "RENE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-26",
"last_updated": "2019-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "57183",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.