MEDICARE: CINDY C JENKINS LPC, MAC LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD0000595	CO
2	101YP2500X	Professional Counselor	5076	CO
3	101YP2500X	Professional Counselor	LPC0005076	CO
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	6703	CO

General Provider Information

NPI Number	:	1063667616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY C JENKINS LPC, MAC LAC

Provider Business Mailing Address
First Line	:	220 RUSKIN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2522
Country	:	US
Telephone Number	:	719-572-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1852 IRWIN DR BLDG 1059
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80913-4176
Country	:	US
Telephone Number	:	719-526-2062
Fax Number	:	719-526-8154

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	02/05/2021

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