Provider Demographics
NPI:1598913139
Name:JENKINS, RYAN K (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:K
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:LA LUZ
Mailing Address - State:NM
Mailing Address - Zip Code:88337-1141
Mailing Address - Country:US
Mailing Address - Phone:575-489-8298
Mailing Address - Fax:
Practice Address - Street 1:530 HARKLE RD STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4739
Practice Address - Country:US
Practice Address - Phone:575-914-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX539491041C0700X
NMX-063681041C0700X
NMC-115311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical