Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 23079 | TX |
N | 103TC0700X | Clinical Psychologist | 23079 | TX |
N | 102L00000X | Psychologist | 23079 | TX |
N | 103T00000X | Psychologist | 23079 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 23079 | TX |
Y | 103G00000X | Clinical Psychologist | 23079 | TX |
Y | 103TC0700X | Clinical Psychologist | 23079 | TX |
NPI | 1477513182 |
---|---|
Provider Name | Dr. Greg W. Jenkins |
First Address | Amarillo, TX 79106-1990 |
Second Address | Amarillo, TX 79106-1990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 13/07/2007 |