Healthcare Provider Details

I. General information

NPI: 1508228438
Provider Name (Legal Business Name): TRENT JENSEN PLMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 S 39TH ST 39TH FLOOR
BELLEVUE NE
68123-5200
US

IV. Provider business mailing address

124 S 24TH ST SUITE 230
OMAHA NE
68102-1226
US

V. Phone/Fax

Practice location:
  • Phone: 402-292-9105
  • Fax: 402-591-5075
Mailing address:
  • Phone: 402-292-9105
  • Fax: 402-591-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: