Provider Demographics
NPI:1528226172
Name:JENKINS, RICHARD (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
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 1:1602 S ELLIOTT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-2133
Mailing Address - Country:US
Mailing Address - Phone:417-229-0413
Mailing Address - Fax:
Practice Address - Street 1:1602 S ELLIOTT AVE STE D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2133
Practice Address - Country:US
Practice Address - Phone:417-229-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010222022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495187403Medicaid