Healthcare Provider Details

I. General information

NPI: 1518109867
Provider Name (Legal Business Name): HALY L. JENSENHOF LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 MAIN ST
TORRINGTON WY
82240-3340
US

IV. Provider business mailing address

P.O. BOX 1117 1419 SOUTH MAIN STREET
TORRINGTON WY
82240
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4197
  • Fax: 307-532-8405
Mailing address:
  • Phone: 307-532-4197
  • Fax: 307-532-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 942
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: