Provider Demographics
NPI:1558307736
Name:JENKINS, ROSELL (PHD)
Entity Type:Individual
Prefix:
First Name:ROSELL
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 502
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4018
Mailing Address - Country:US
Mailing Address - Phone:281-447-9355
Mailing Address - Fax:281-447-9356
Practice Address - Street 1:505 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 502
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4018
Practice Address - Country:US
Practice Address - Phone:281-447-9355
Practice Address - Fax:281-447-9356
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170339901Medicaid
TX611293Medicaid