Healthcare Provider Details

I. General information

NPI: 1073971685
Provider Name (Legal Business Name): HARRIS R. JENSEN, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 JOHN F KENNEDY PKWY SUITE 210
FORT COLLINS CO
80525-2635
US

IV. Provider business mailing address

3500 JOHN F KENNEDY PKWY SUITE 210
FORT COLLINS CO
80525-2635
US

V. Phone/Fax

Practice location:
  • Phone: 970-416-8354
  • Fax: 970-416-0354
Mailing address:
  • Phone: 970-416-8354
  • Fax: 970-416-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARRIS ROBERT JENSEN
Title or Position: OWNER
Credential: M.D.
Phone: 970-217-3370