Provider Demographics
NPI:1124077011
Name:JENKINS, SHIRLEY J (LMSW ACSW)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 CAYUGA DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8691
Mailing Address - Country:US
Mailing Address - Phone:248-842-7043
Mailing Address - Fax:248-842-7043
Practice Address - Street 1:3417 CAYUGA DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-8691
Practice Address - Country:US
Practice Address - Phone:248-842-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010612091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical