Individual provider Active NPI

Lakisha Hill, DOCTOR OF PSYCHOLOGY

  • Clinical Psychologist
  • Fort Worth, TX
National Provider Identifier
1790594364
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
40503 Issued in TX
Practice address
1550 W Rosedale St Ste 518
Fort Worth, TX 76104-7403
Phone
(817) 348-8351
NPI assigned
Jan 7, 2025
Last updated
Jan 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 40503 TX
Clinical Psychologist 103TC0700X 40503 TX Primary

Addresses

Primary practice location

1550 W Rosedale St Ste 518
Fort Worth, TX 76104-7403

Mailing address

8733 Shavano Dr
Fort Worth, TX 76123-4009
Phone (805) 616-8348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20250110002039 TX Practitioner - Clinical Psychologist 4587192026 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Geriatric Services P C Clinical CurrentSince Jan 8, 2025 Accepting new patients
Deer Oaks Mental Health Associates PC Clinical PastSince Jan 12, 2025 Accepting new patients

Locations

1550 W Rosedale St
Ste 518
Ft Worth, TX 76104
Phone (817) 348-8351

7272 Wurzbach Rd
Ste 706
San Antonio, TX 78240
Phone (210) 615-3401

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1790594364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8733 SHAVANO DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761234009",
            "telephone_number": "805-616-8348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 W ROSEDALE ST STE 518",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047403",
            "telephone_number": "817-348-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILL",
        "first_name": "LAKISHA",
        "credential": "DOCTOR OF PSYCHOLOGY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "40503",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "40503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.