MEDICARE: NICOLE JENSEN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4671	MT

General Provider Information

NPI Number	:	1164857975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JENSEN LCPC

Provider Business Mailing Address
First Line	:	PO BOX 21352
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59104-1352
Country	:	US
Telephone Number	:	406-697-6406
Fax Number	:	406-254-1674

Provider Business Practice Location Address
First Line	:	3021 6TH AVE N
Second Line	:	STE 110
City	:	BILLINGS
State	:	MT
Zip	:	59101-1145
Country	:	US
Telephone Number	:	406-697-6406
Fax Number	:	406-254-1674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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