Provider Demographics
NPI:1790164366
Name:JENKINS, COREY (M,S)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:M,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2747
Mailing Address - Country:US
Mailing Address - Phone:225-245-9070
Mailing Address - Fax:225-245-9070
Practice Address - Street 1:555 SAINT TAMMANY ST STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6064
Practice Address - Country:US
Practice Address - Phone:225-929-9738
Practice Address - Fax:225-929-9740
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor