Provider Demographics
NPI:1235347014
Name:JENKINS, TIMOTHY DAVID (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 122ND CT NE APT A103
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5882
Mailing Address - Country:US
Mailing Address - Phone:425-896-8614
Mailing Address - Fax:
Practice Address - Street 1:12309 15TH AVE NE STE D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4864
Practice Address - Country:US
Practice Address - Phone:425-273-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist