Provider Demographics
NPI:1629405865
Name:JENKINS, DAVID SETH (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SETH
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 1:5345 E. VANBUREN #161
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008
Mailing Address - Country:US
Mailing Address - Phone:480-318-9707
Mailing Address - Fax:
Practice Address - Street 1:1351 N ALMA SCHOOL RD STE 205
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5937
Practice Address - Country:US
Practice Address - Phone:480-491-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC14025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional