Provider Information for 1578033445
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JANEEN JENKINS LPC
Sex: Female
NPI: 1578033445
Last Updated: 2021-04-01
Certification Date: 2021-04-01
Certification Date: 2021-04-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1578033445 | ||||||||||||
| Enumeration Date | 2018-12-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3003 KNIGHT ST STE 115 SHREVEPORT, LA 71105-2561 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 3003 KNIGHT ST STE 115 SHREVEPORT, LA 71105-2561 United States Phone: 318-398-0945 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1513 LINE AVENUE | ||||||||||||
| Health Information Exchange |
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