Provider Demographics
NPI:1811203995
Name:JENKINS, ELIZABETH ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 CAMINO DEL RIO N.
Mailing Address - Street 2:STE. 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-248-9351
Mailing Address - Fax:619-584-5644
Practice Address - Street 1:3570 CAMINO DEL RIO N.
Practice Address - Street 2:STE. 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-248-9351
Practice Address - Fax:619-584-5644
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist