Healthcare Provider Details

I. General information

NPI: 1346503877
Provider Name (Legal Business Name): DENISE MARIE JENSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 UNIVERSITY DR
GOODING ID
83330-6155
US

IV. Provider business mailing address

1405 HEYBURN AVE E
TWIN FALLS ID
83301-4856
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-5880
  • Fax: 208-934-5876
Mailing address:
  • Phone: 208-339-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-4914
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: