Healthcare Provider Details

I. General information

NPI: 1326343054
Provider Name (Legal Business Name): ELLEN ELIZABETH JENSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SW CASCADE AVE STE 90C
STEVENSON WA
98648-6284
US

IV. Provider business mailing address

PO BOX 407
STEVENSON WA
98648
US

V. Phone/Fax

Practice location:
  • Phone: 503-422-7764
  • Fax:
Mailing address:
  • Phone: 503-422-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60207150
License Number StateWA

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: