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General NPI Number Information
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NPI Number | 1700295888
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Entity Type | Individual
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Provider Name | BRYAN JENSEN PHD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 07/05/2017
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Provider Practice Location Address
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Address Line | 1703 DRESDEN RD APT A
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City | RICHMOND
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State | VA
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Zip | 23229-4037
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Country | US
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Telephone | 801-830-5593
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Fax |
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Provider Business Mailing Address
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Address Line | 629 ORCHARD DRIVE APT 8
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City | BOUNTIFUL
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State | UT
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Zip | 84010
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 10235130-2501
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License Number State | UT
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