Healthcare Provider Details

I. General information

NPI: 1710301056
Provider Name (Legal Business Name): AMANDA JENSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W BANNOCK ST STE 1100
BOISE ID
83702-6140
US

IV. Provider business mailing address

950 W BANNOCK ST STE 1100
BOISE ID
83702-6140
US

V. Phone/Fax

Practice location:
  • Phone: 646-453-6777
  • Fax:
Mailing address:
  • Phone: 323-205-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-6244
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: