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NPI Code Detail

MEDICARE: EVANDER JENSEN

MEDICARE: EVANDER JENSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1770363780
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVANDER JENSEN
Provider Business Mailing Address
First Line : 8915 SW CENTER ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-6307
Country : US
Telephone Number : 503-726-3690
Fax Number :
Provider Business Practice Location Address
First Line : 8915 SW CENTER ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-6307
Country : US
Telephone Number : 503-726-3690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2023
Last Update Date : 04/06/2026

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Directions to “ EVANDER JENSEN ” Practice Location

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