Jeanine Marshall Tillman

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

87375 Issued in TX

Practice address

18665 Midway Rd Apt 2117
Dallas, TX 75287-3955

Phone

(146) 995-1121

NPI assigned

Aug 10, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kenyatta Black Counseling LLC

  • Professional Counselor
  • Arlington, TX
  • NPI 1275010308
  NPD (past)

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1700514593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12895 JOSEY LN STE 124",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752348300",
            "telephone_number": "469-951-1218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18665 MIDWAY RD APT 2117",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752873955",
            "telephone_number": "146-995-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL TILLMAN",
        "first_name": "JEANINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-10",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "87375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Skoposcounseling@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PO Box",
            "address_1": "12895 Josey Ln Ste 124",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752348300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chad A Marsden, M.D.
• Marsh Lane Dental PA
• Tracey Dawn Marsh, RN, CPNP
• Adrienne Anne Marshall Daughtry, WHNP
• Marshall Eye Care
• Deborah Ann Marshall-Brown, LPC
• Amanda Lea Marshall, MD
• Antonya Marshall
• Breshena D'Onne Marshall, PA
• Brian Dean Marshall, O.D.

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.