Healthcare Provider Details

I. General information

NPI: 1184914954
Provider Name (Legal Business Name): MARTEEN JENSEN, LPC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NE ROBERTS AVE STE 350
GRESHAM OR
97030-7486
US

IV. Provider business mailing address

510 NE ROBERTS AVE STE 350
GRESHAM OR
97030-7486
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-0811
  • Fax: 503-491-0462
Mailing address:
  • Phone: 503-491-0811
  • Fax: 503-491-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC1184
License Number StateOR

VIII. Authorized Official

Name: MS. MARTEEN JENSEN
Title or Position: PRESIDENT
Credential: LPC
Phone: 503-491-0811