Provider Demographics
NPI:1992365910
Name:JENKINS, MARY R (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6614
Mailing Address - Country:US
Mailing Address - Phone:281-357-4111
Mailing Address - Fax:
Practice Address - Street 1:333 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6614
Practice Address - Country:US
Practice Address - Phone:281-357-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional