Provider Information for 1518484849
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JASON TODD JENKINS MABC LPC
Sex: Male
NPI: 1518484849
Last Updated: 2017-08-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1518484849 | ||||||||
| Enumeration Date | 2017-08-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2811 ACADIA ST MARSHALL, TX 75672-7507 United States Phone: 903-399-9208 | Fax: | ||||||||
| Primary Practice Address | 3800 PALUXY DR STE 240 TYLER, TX 75703-1667 United States Phone: 903-283-8729 | Fax:888-454-9083 | ||||||||
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