MEDICARE: MRS. DETRIA S JENKINS

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	9219	LA

General Provider Information

NPI Number	:	1063697019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DETRIA S JENKINS

Provider Business Mailing Address
First Line	:	PO BOX 1222
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71294-1222
Country	:	US
Telephone Number	:	318-387-3545
Fax Number	:	318-387-3541

Provider Business Practice Location Address
First Line	:	617 N 2ND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-6235
Country	:	US
Telephone Number	:	318-387-3545
Fax Number	:	318-387-3541

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

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	03/12/2026

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