Provider Demographics
NPI:1346209541
Name:JENKINS, TERRY (PSYD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 SE CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-7161
Mailing Address - Country:US
Mailing Address - Phone:503-786-2171
Mailing Address - Fax:503-794-5905
Practice Address - Street 1:8305 SE MONTEREY AVENUE
Practice Address - Street 2:SUITE 219
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266
Practice Address - Country:US
Practice Address - Phone:503-786-2171
Practice Address - Fax:503-794-5905
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1244103T00000X
ORT0178106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist