Active NPI
Tishara A. Jackson, ED.D, LCDC, CSC
- Mental Health Counselor
- Fort Worth, TX
National Provider Identifier
1477319119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 15299
- Practice address
- 8201 Southbrook Cir
Fort Worth, TX 76134-5332 - Phone
- (773) 996-3797
- NPI assigned
- Feb 21, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 15299 | TX | Primary |
Addresses
Primary practice location
8201 Southbrook Cir
Fort Worth, TX 76134-5332
Mailing address
5613 Mount Storm Way
Fort Worth, TX 76179-4438
Phone (773) 996-3797
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15299 | TX | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intentional Hearts Counseling and Consulting PLLC | Mental Health | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Fort Worth, TX
- NPI 1720858947
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743552000000",
"number": "1477319119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5613 MOUNT STORM WAY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761794438",
"telephone_number": "773-996-3797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8201 SOUTHBROOK CIR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761345332",
"telephone_number": "773-996-3797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TISHARA",
"middle_name": "A.",
"credential": "ED.D, LCDC, CSC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-21",
"last_updated": "2025-04-02",
"certification_date": "2025-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "15299",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.