Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JAZMYNE TIDWELL LMHC
NPI 1003799669
Counselor - Mental Health in Indianapolis, IN

Q: What is Jazmyne Tidwell's NPI number?

The NPI number for Jazmyne Tidwell is 1003799669. It was assigned to this individual provider in the NPPES registry on July 30, 2025.

Q: What is Jazmyne Tidwell's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Jazmyne Tidwell was last updated on August 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 30, 2025PECOS Enrolled

2506 WILLOWBROOK PKWY STE 300, INDIANAPOLIS, IN 46205(317) 574-1254(317) 674-0060 Get Directions Write a Review

NPPES record last updated: August 5, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 5, 2026, Apr 2, 2026, Dec 30, 2025 (3 updates tracked since 2025).

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About Jazmyne Tidwell Lmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAZMYNE TIDWELL LMHC (NPI 1003799669) is an individual mental health provider in Indianapolis, Indiana, licensed in Indiana (39005576A) and active in the NPI registry since July 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1003799669

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameJAZMYNE TIDWELLCredential: LMHC

Location Address2506 WILLOWBROOK PKWY STE 300Indianapolis, IN 46205-1500

Mailing Address697 Pro Med LnCarmel, IN 46032-5323 · (317) 574-1254 · Fax (317) 674-0060

Phone(317) 574-1254

Fax(317) 674-0060

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateJuly 30, 2025

Last NPPES UpdateAugust 5, 20263 updates tracked since enumeration

NPPES CertifiedAugust 5, 2026

✔ NPI 1003799669 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in IN · 39005576A

2506 WILLOWBROOK PKWY STE 300, Indianapolis, IN 46205

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jazmyne Tidwell Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6901305721

PECOS Enrollment IDI20250819001803

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MISS STEPHANIE DIANE SANCHEZ MSW, LCSW

Social Worker (Clinical)