Jacob O Wasonga, PH.D, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

203024 Issued in TX

Practice address

1124 Galveston Ave Ste B
Fort Worth, TX 76104-4878

Phone

(210) 420-8117

NPI assigned

Sep 23, 2019

Sex

Male

Sole proprietor

Yes

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

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

Specialty

Marriage and Family Therapist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brightside Medical PCGroup PAC ID 6608262464, 274 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Brightside Medical, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1801355482

  Single Specialty, TX

  Medicare reassignment Care Compare group NPD
• The Magnolia Clinic, LLC

  • Marriage & Family Therapist
  • Fort Worth, TX
  • NPI 1629731302
  NPD Authorized official

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1861043713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 592732",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782590186",
            "telephone_number": "817-609-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 GALVESTON AVE STE B",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044878",
            "telephone_number": "210-420-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASONGA",
        "first_name": "JACOB",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "PH.D, LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-23",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "203024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Princess Washington
• Raynal Jeremy Washington
• Sheba Jory Washington, PHARM D
• Yolanda Washington
• Ryan Wasilewski, DC
• Brian David Wasson, M.D.
• Lori Wasson, D.O.
• Watauga Family Practice PA
• Isaac Aaron Watemberg, MD
• Donald Edward Watenpaugh, PH.D.

• Marriage & Family Therapist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Marriage & Family Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.