MEDICARE: DR. FLOYD JAMES JENSEN III PSY.D.

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	103TC0700X	Clinical Psychologist	30791	TX

General Provider Information

NPI Number	:	1750416954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLOYD JAMES JENSEN III PSY.D.

Provider Business Mailing Address
First Line	:	1701 RIVER RUN
Second Line	:	SUITE 404
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	817-332-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 RIVER RUN
Second Line	:	SUITE 404
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	817-332-8002
Fax Number	:	817-332-8063

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/09/2007

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