Healthcare Provider Details

I. General information

NPI: 1861213977
Provider Name (Legal Business Name): REBECCA JENSEN MFTC.0014321
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CITADEL DR E STE 250
COLORADO SPRINGS CO
80909-5488
US

IV. Provider business mailing address

1733 CREST PL
COLORADO SPRINGS CO
80911-1109
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-9342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0014321
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: