1. Home
  2. Directory
  3. Ohio
  4. Dayton
  5. Counselor
  6. NPI Profile

JENISE ELAINE TIDD LICDC-CS
NPI 1447765821
Counselor - Addiction (Substance Use Disorder) in Dayton, OH

Active since December 07, 2017PECOS Enrolled
865 S PATTERSON BLVD, DAYTON, OH 45402(937) 966-4673 Get Directions Write a Review

NPPES record last updated: February 16, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 16, 2022, Jul 16, 2020, Dec 7, 2017 (3 updates tracked since 2017).

About Jenise Elaine Tidd Licdc-cs NPPES

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

JENISE ELAINE TIDD LICDC-CS (NPI 1447765821) is an individual addiction (substance use disorder) provider in Dayton, Ohio, licensed in Ohio (LICDC.161533) and active in the NPI registry since December 2017. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1447765821
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameJENISE ELAINE TIDDCredential: LICDC-CS
Location Address865 S PATTERSON BLVDDayton, OH 45402-2624
Mailing Address100 Crowne Point PlCincinnati, OH 45241-5427 · (513) 743-7628
Phone(937) 966-4673
Sole ProprietorNo
Enumeration DateDecember 7, 2017
Last NPPES UpdateFebruary 16, 20243 updates tracked since enumeration
NPPES CertifiedFebruary 16, 2024
✔ NPI 1447765821 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
Licenses✔ Licensed in OH · LICDC.161533✔ Licensed in OH · 161533
865 S PATTERSON BLVD, Dayton, OH 45402
Open in Google Maps ↗

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jenise Elaine Tidd Licdc-cs is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Jenise Tidd reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Decoach Team LLC
36 mi
Rehabilitation, Substance Use Disorder
100 CROWNE POINT PL
Cincinnati, OH 45241
  • Reassigned Medicare billing, Ohio enrollment
  • 33 clinicians in this Medicare group
NPI 1366992224 (513) 743-7628

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

TONTIONIA CHAPPEL
Licensed Practical Nurse
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673
EMILY RALEIGH
Licensed Practical Nurse
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673
PHILLIP JOHNSON
Counselor
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673
LAURALE HOLCOMB
Licensed Practical Nurse
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673
DOMINIQUE SANDIFER
Case Manager/Care Coordinator
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673
RYAN PROFITT
Case Manager/Care Coordinator
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673
NICOLE HOWARD
Licensed Practical Nurse
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673
CAROL A STEPHENS
Case Manager/Care Coordinator
865 S PATTERSON BLVD
DAYTON, OH 45402
Montgomery County (937) 966-4673

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jenise Tidd's NPI number?

The NPI number for Jenise Tidd is 1447765821. It was assigned to this individual provider in the NPPES registry on December 7, 2017.

Where is Jenise Tidd located?

Jenise Tidd practices at 865 S Patterson Blvd, Dayton, OH 45402. The listed phone number is (937) 966-4673.

What is Jenise Tidd's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Jenise Tidd enrolled in Medicare?

Yes. Jenise Tidd is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jenise Tidd's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jenise Tidd reassigns Medicare benefits to Decoach Team LLC (Cincinnati, OH). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jenise Tidd's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jenise Tidd accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, MedMutual, Molina Healthcare and Oscar Health Insurance and 1 other insurer list Jenise Tidd as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jenise Tidd was last updated on February 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.