Tissan Tilden Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C10433 Issued in MS

Practice address

3450 Highway 80 W
Jackson, MS 39209-7201

Phone

(601) 321-2400

Fax

(601) 985-5174

NPI assigned

Jun 1, 2009

Last updated

Sep 4, 2024By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

• Change Happens Counseling Center, LLC

  • Social Worker
  • Byram, MS
  • NPI 1154700748
  Authorized official Same address or phone

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

{
    "created_epoch": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1619103959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 HIGHWAY 80 W",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392097201",
            "telephone_number": "601-316-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 HIGHWAY 80 W",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392097201",
            "telephone_number": "601-321-2400",
            "fax_number": "601-985-5174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 N Congress St",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392011902",
            "country_code": "US",
            "telephone_number": "601-326-3735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TISSAN",
        "middle_name": "TILDEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-01",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C10433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Terry Jackson, M.D.
• Roshanda Delynn Jackson, LCSW
• Shutellia Jackson
• Taylor Nicole Jackson
• Terica Herron Jackson, M.D.
• Tonya Jackson, MT-BC
• Marvin Jacob
• Sebastian John Jacobi, D.O.
• Jade Clinical Supervision and Consultation, LLC
• Navkiran Singh Jagdev, MD

• Clinical Social Worker in Jackson, MS
• Providers in Jackson, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.