Basic Information
| Provider Information | |||||||||
| NPI: | 1891015418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | PERRY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MA, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5170 HEATHERTON DR | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711117825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184700931 | ||||||||
| FaxNumber: | 3186589012 | ||||||||
| Practice Location | |||||||||
| Address1: | 5170 HEATHERTON DR | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711117825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184700931 | ||||||||
| FaxNumber: | 3186589012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2010 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3671 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 3671 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.