MEDICARE: MR. JAMES PERRY JENKINS JR. MA, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3671	LA
2	101YM0800X	Mental Health Counselor	3671	LA

General Provider Information

NPI Number	:	1891015418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES PERRY JENKINS JR. MA, LPC, NCC

Provider Business Mailing Address
First Line	:	5170 HEATHERTON DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7825
Country	:	US
Telephone Number	:	318-470-0931
Fax Number	:	318-658-9012

Provider Business Practice Location Address
First Line	:	5170 HEATHERTON DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7825
Country	:	US
Telephone Number	:	318-470-0931
Fax Number	:	318-658-9012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	12/28/2022

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