Provider Demographics
NPI:1841763752
Name:JENKINS, GRIFFITH
Entity Type:Individual
Prefix:
First Name:GRIFFITH
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W FRONT ST STE 302
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5122
Mailing Address - Country:US
Mailing Address - Phone:208-917-2086
Mailing Address - Fax:208-330-4447
Practice Address - Street 1:401 W FRONT ST STE 302
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5122
Practice Address - Country:US
Practice Address - Phone:208-917-2086
Practice Address - Fax:208-330-4447
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011284101YM0800X
MI6401222794101YM0800X
IDLPC-8121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health