Provider Demographics
NPI:1962483362
Name:JENKINS, DAVID ALLEN (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 S HULEN ST
Mailing Address - Street 2:SUITE 674
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4907
Mailing Address - Country:US
Mailing Address - Phone:817-808-3676
Mailing Address - Fax:
Practice Address - Street 1:4200 S HULEN ST
Practice Address - Street 2:SUITE 674
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4907
Practice Address - Country:US
Practice Address - Phone:817-808-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00989PMedicare ID - Type Unspecified