Provider Demographics
NPI:1801398722
Name:JENKINS, ROBERT (TRAINING IN BAHVIOR)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:TRAINING IN BAHVIOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHURCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6287
Mailing Address - Country:US
Mailing Address - Phone:256-459-5600
Mailing Address - Fax:
Practice Address - Street 1:116 CHURCH ST STE 4
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6287
Practice Address - Country:US
Practice Address - Phone:256-459-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171W00000X
251S00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171W00000XOther Service ProvidersContractor
No251S00000XAgenciesCommunity/Behavioral Health