Jenise Elaine Tidd, LICDC-CS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LICDC.161533 Issued in OH

Practice address

865 S Patterson Blvd
Dayton, OH 45402-2624

Phone

(937) 966-4673

NPI assigned

Dec 7, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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.

• Decoach Team LLC

  dba DeCoach Rehabilitation Centre

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cincinnati, OH
  • NPI 1366992224
  Medicare reassignment
• Decoach Team LLC

  dba DeCoach Rehabilitation Centre

  • Adult Mental Health Clinic/Center
  • Cincinnati, OH
  • NPI 1578037552
  NPD

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

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1447765821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CROWNE POINT PL",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452415427",
            "telephone_number": "513-743-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 S PATTERSON BLVD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454022624",
            "telephone_number": "937-966-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDD",
        "first_name": "JENISE",
        "middle_name": "ELAINE",
        "credential": "LICDC-CS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "161533",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.161533",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah Thurston, AG-ACNP
• Paige U Tibbetts
• Jeffrey A Tibbs, CDCA
• Stanley Titang Tibong, DNP
• Krista Lynn Tice
• Mackenzie R Tiderington, P.A-C
• Alissa Tidwell
• Christopher W Tidwell, D.O.
• Diane Tidwell
• Stephany Tidwell

• Addiction (Substance Use Disorder) Counselor in Dayton, OH
• Providers in Dayton, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.