Healthcare Provider Details

I. General information

NPI: 1134932411
Provider Name (Legal Business Name): SCOTT JENSON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 E RIVER DR
TEMPLE TERRACE FL
33617-7839
US

IV. Provider business mailing address

809 E RIVER DR
TEMPLE TERRACE FL
33617-7839
US

V. Phone/Fax

Practice location:
  • Phone: 813-416-2573
  • Fax:
Mailing address:
  • Phone: 813-416-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: