Provider Demographics
NPI:1053054650
Name:JENKINS, MARVEL CHANTEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARVEL
Middle Name:CHANTEL
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 JENNY DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-0323
Mailing Address - Country:US
Mailing Address - Phone:817-933-0376
Mailing Address - Fax:
Practice Address - Street 1:1007 JENNY DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-0323
Practice Address - Country:US
Practice Address - Phone:817-933-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health