MEDICARE: TISHA R 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	4482-C	AR
2	104100000X	Social Worker	2581-M	AR

General Provider Information

NPI Number	:	1912230889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TISHA R JENKINS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 224
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-0224
Country	:	US
Telephone Number	:	501-786-9308
Fax Number	:	818-864-0043

Provider Business Practice Location Address
First Line	:	404 E PAGE AVE
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-4248
Country	:	US
Telephone Number	:	501-786-9308
Fax Number	:	818-864-0043

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

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	01/09/2026

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Directions to “ TISHA R JENKINS LCSW” Practice Location

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