Jill Marie Ingersoll, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

67137 Issued in TX

Practice address

1010 Blue Water Dr
Canyon Lake, TX 78133-5584

Phone

(180) 848-9543

NPI assigned

Feb 1, 2024

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

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

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

S Kincheloe Counseling PLLCGroup PAC ID 4688061955, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• S Kincheloe Counseling PLLC

  • Clinical Social Worker
  • Austin, TX
  • NPI 1487361143
  Medicare reassignment Care Compare group NPD
• Blue Water Therapists, PLLC

  • Clinical Social Worker
  • Canyon Lake, TX
  • NPI 1093546152
  NPD Authorized official

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1912760901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 BLUE WATER DR",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781335584",
            "telephone_number": "808-489-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 BLUE WATER DR",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781335584",
            "telephone_number": "180-848-9543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGERSOLL",
        "first_name": "JILL",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "67137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Yong Henderson, LMSW, LCDC
• Tara Henry, LCDC-I
• Hill Country Chiropractic Clinic
• Hill Country Surgical Assistants
• Sheryl Rene Hopper, LPC
• Innate Ability LLC
• Crystal James
• Angela Jetter
• Joseph Lee Kastigar
• Heather Kopecki, LCSW

• Clinical Social Worker in Canyon Lake, TX
• Providers in Canyon Lake, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.