Healthcare Provider Details

I. General information

NPI: 1093307167
Provider Name (Legal Business Name): FALICIA J JENSEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 N 1ST ST STE 105-503
FRESNO CA
93710-6200
US

IV. Provider business mailing address

2820 AMALFI
CHOWCHILLA CA
93610-9456
US

V. Phone/Fax

Practice location:
  • Phone: 559-223-6084
  • Fax:
Mailing address:
  • Phone: 559-223-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number123860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: