Provider Demographics
NPI:1639613292
Name:JENKINS, SHIVA (MA)
Entity type:Individual
Prefix:MS
First Name:SHIVA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 E DICKENSON PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6012
Mailing Address - Country:US
Mailing Address - Phone:720-432-8418
Mailing Address - Fax:303-623-1807
Practice Address - Street 1:1440 A GROVE STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2201
Practice Address - Country:US
Practice Address - Phone:720-432-8418
Practice Address - Fax:303-623-1807
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0107097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health