Healthcare Provider Details

I. General information

NPI: 1982970026
Provider Name (Legal Business Name): TARA LEMLEY JENSEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 BALLARD AVE NW STE 4
SEATTLE WA
98107
US

IV. Provider business mailing address

PO BOX 520484
SALT LAKE CITY UT
84152-0484
US

V. Phone/Fax

Practice location:
  • Phone: 206-696-2024
  • Fax:
Mailing address:
  • Phone: 206-696-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60079356
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60279152
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: