Provider Demographics
NPI:1699207100
Name:TIRRELL, JESSIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:TIRRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-4871
Mailing Address - Fax:682-885-3936
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:STE 6100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-1640
Practice Address - Fax:682-885-1062
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical