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General NPI Number Information
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NPI Number | 1063637486
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Entity Type | Individual
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Provider Name | LAURA LEA JENSEN PHD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 9414 W LAKE MEAD BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89134-8312
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Country | US
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Telephone | 702-498-0871
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Fax | 702-445-6434
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Provider Business Mailing Address
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Address Line | 9213 LAS MANAITAS AVE UNIT 401
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City | LAS VEGAS
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State | NV
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Zip | 89144-6631
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Country | US
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Telephone | 702-498-0871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2585
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY0851
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License Number State | NV
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