Healthcare Provider Details

I. General information

NPI: 1285014761
Provider Name (Legal Business Name): JESSICA JENSEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MARIANNA WAY UNIT 102
BLUFFTON SC
29910-9080
US

IV. Provider business mailing address

6 MARIANNA WAY UNIT 102
BLUFFTON SC
29910-9080
US

V. Phone/Fax

Practice location:
  • Phone: 774-608-6829
  • Fax: 508-619-3384
Mailing address:
  • Phone: 774-608-6829
  • Fax: 508-219-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: