MEDICARE: MR. RYAN K JENKINS LCSW

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	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	53949	TX
3	1041C0700X	Clinical Social Worker	X-06368	NM
4	1041C0700X	Clinical Social Worker	C-11531	NM

General Provider Information

NPI Number	:	1598913139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN K JENKINS LCSW

Provider Business Mailing Address
First Line	:	1980 E LOHMAN AVE STE E
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3194
Country	:	US
Telephone Number	:	575-914-2634
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 E LOHMAN AVE STE E
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3194
Country	:	US
Telephone Number	:	575-914-2634
Fax Number	:

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	05/15/2024

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