Healthcare Provider Details

I. General information

NPI: 1265951388
Provider Name (Legal Business Name): NEILL J JENSON LPC, NCC, NCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6933 W EMERALD ST
BOISE ID
83704-8616
US

IV. Provider business mailing address

6933 W EMERALD ST
BOISE ID
83704-8616
US

V. Phone/Fax

Practice location:
  • Phone: 208-321-0634
  • Fax:
Mailing address:
  • Phone: 208-321-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6584
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: