Provider Demographics
NPI:1922560168
Name:JENKINS, LAFAYETTE ERVIN (LMHC, LPHA, CAMS-3)
Entity Type:Individual
Prefix:MR
First Name:LAFAYETTE
Middle Name:ERVIN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LMHC, LPHA, CAMS-3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12288 HAMLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-2301
Mailing Address - Country:US
Mailing Address - Phone:561-644-4400
Mailing Address - Fax:
Practice Address - Street 1:8895 N. MILITARY TRAIL, SUITE 300C
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-644-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8509101YM0800X
FLMH19498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health