MEDICARE: TIMOTHY RAY JENKINS BS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194699454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY RAY JENKINS BS

Provider Business Mailing Address
First Line	:	4844 CALLE BELLA AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7066
Country	:	US
Telephone Number	:	575-382-5973
Fax Number	:	575-541-3635

Provider Business Practice Location Address
First Line	:	4844 CALLE BELLA AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7066
Country	:	US
Telephone Number	:	575-382-5973
Fax Number	:	575-541-3635

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

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	01/12/2026

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