Healthcare Provider Details

I. General information

NPI: 1801454004
Provider Name (Legal Business Name): BARBARA LYNN JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 1ST ST NW
ALBUQUERQUE NM
87102-1529
US

IV. Provider business mailing address

PO BOX 25445
ALBUQUERQUE NM
87125-0445
US

V. Phone/Fax

Practice location:
  • Phone: 505-767-1167
  • Fax: 505-242-9699
Mailing address:
  • Phone: 505-767-1167
  • Fax: 505-242-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACB-7329
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: