Provider Demographics
NPI:1629741103
Name:JENKINS, LEAH MARI-ANN
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARI-ANN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 SEWANEE PL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-2884
Mailing Address - Country:US
Mailing Address - Phone:615-975-6223
Mailing Address - Fax:
Practice Address - Street 1:319 W MCKNIGHT DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2450
Practice Address - Country:US
Practice Address - Phone:615-896-9160
Practice Address - Fax:615-890-4555
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5422OtherTN BOARD OF PROFESSIONAL COUNSELORS AND MARITAL & FAMILY THERAPISTS