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General NPI Number Information
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NPI Number | 1861865297
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Entity Type | Individual
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Provider Name | MS. JENNA MORTENSEN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 1011 PACIFIC ST STE 200
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3600
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Country | US
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Telephone | 805-329-8051
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Fax |
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Provider Business Mailing Address
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Address Line | 320 15TH AVE W APT 309
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City | EVELETH
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State | MN
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Zip | 55734-1144
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Country | US
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Telephone | 805-329-8051
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 10654
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10654
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19190
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19190
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License Number State | CA
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