Provider Demographics
NPI:1205119062
Name:JENKINS, RUSSELL ALDEN (PHD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ALDEN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 E 7TH ST # 116B
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:310-290-9728
Mailing Address - Fax:814-860-2110
Practice Address - Street 1:5901 E 7TH ST # 116B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:310-290-9728
Practice Address - Fax:814-860-2110
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical