| Tisha R. Jenkins, Lcsw P.a. | |
|
302 S Main St Malvern AR 72104-3737 | |
| (501) 786-9308 | |
| Not Available |
| Full Name | Tisha R. Jenkins, Lcsw P.a. |
|---|---|
| Speciality | Social Worker |
| Location | 302 S Main St, Malvern, Arkansas |
| Authorized Official Name and Position | Tisha R. Jenkins (OWNER) |
| Authorized Official Contact | 5017869308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tisha R. Jenkins, Lcsw P.a. 302 S Main St Malvern AR 72104-3737 Ph: (501) 786-9308 | Tisha R. Jenkins, Lcsw P.a. 302 S Main St Malvern AR 72104-3737 Ph: (501) 786-9308 |
| NPI Number | 1437524170 |
|---|---|
| Provider Enumeration Date | 12/07/2015 |
| Last Update Date | 04/15/2024 |
| Certification Date | 04/15/2024 |
| Medicare PECOS PAC ID | 3779975289 |
|---|---|
| Medicare Enrollment ID | O20220113000455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437524170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 4482-C (Arkansas) | Primary |
| Provider Name | Tisha Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912230889 PECOS PAC ID: 7719207414 Enrollment ID: I20150520002051 |
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