Healthcare Provider Details

I. General information

NPI: 1710357058
Provider Name (Legal Business Name): CLARE LIZBETH JENSEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRACELAND DR SE
ALBUQUERQUE NM
87108-2778
US

IV. Provider business mailing address

301 GRACELAND DR SE
ALBUQUERQUE NM
87108-2778
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1756
  • Fax: 505-255-1293
Mailing address:
  • Phone: 505-255-1756
  • Fax: 505-255-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0163851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: