Healthcare Provider Details

I. General information

NPI: 1346209541
Provider Name (Legal Business Name): TERRY JENKINS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12008 SW GARDEN PL
TIGARD OR
97223-8263
US

IV. Provider business mailing address

12008 SW GARDEN PL
PORTLAND OR
97223-8263
US

V. Phone/Fax

Practice location:
  • Phone: 503-786-2171
  • Fax: 503-794-5905
Mailing address:
  • Phone: 503-740-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1244
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: