Healthcare Provider Details

I. General information

NPI: 1689296071
Provider Name (Legal Business Name): MS. CHYANNE DESTINI JEAN JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 BELLE MILL RD
RED BLUFF CA
96080-2850
US

IV. Provider business mailing address

118 BELLE MILL RD
RED BLUFF CA
96080-2850
US

V. Phone/Fax

Practice location:
  • Phone: 530-840-2000
  • Fax:
Mailing address:
  • Phone: 530-712-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW124330
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: