Provider Demographics
NPI:1255669958
Name:JENKINS, DEIDRE (LMFT)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473 W LAKE MEAD BLVD
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0265
Mailing Address - Country:US
Mailing Address - Phone:702-303-1899
Mailing Address - Fax:702-228-2760
Practice Address - Street 1:7473 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0265
Practice Address - Country:US
Practice Address - Phone:702-562-1232
Practice Address - Fax:702-562-1287
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist