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NPI Code Detail

MEDICARE: MICHAEL JENSEN

MEDICARE: MICHAEL JENSEN
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1710167242
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JENSEN
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 541-858-8170
Fax Number : 541-858-8167
Provider Business Practice Location Address
First Line : 17720 NE HALSEY ST STE B
Second Line :
City : PORTLAND
State : OR
Zip : 97230-6771
Country : US
Telephone Number : 503-654-7654
Fax Number : 503-654-7333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2007
Last Update Date : 12/21/2017

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Directions to “ MICHAEL JENSEN ” Practice Location

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