Provider Demographics
NPI:1871727453
Name:JENKINS, BROOK ELIZABETH (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:BROOK
Middle Name:ELIZABETH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 E 9TH ST
Mailing Address - Street 2:RM. 202
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5550
Mailing Address - Country:US
Mailing Address - Phone:970-259-5818
Mailing Address - Fax:970-403-3104
Practice Address - Street 1:150 E 9TH ST
Practice Address - Street 2:RM. 202
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5550
Practice Address - Country:US
Practice Address - Phone:970-259-5818
Practice Address - Fax:970-403-3104
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5480OtherANTHEM BLUE CROSS/BLUE SHIELD