Provider Demographics
NPI:1982490462
Name:JENKINS, TEVIN LAMARR
Entity type:Individual
Prefix:
First Name:TEVIN
Middle Name:LAMARR
Last Name:JENKINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 GARFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-3375
Mailing Address - Country:US
Mailing Address - Phone:615-717-7632
Mailing Address - Fax:
Practice Address - Street 1:991 GARFIELD WAY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3375
Practice Address - Country:US
Practice Address - Phone:615-717-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician