MEDICARE: DR. ALICE GAYLE JENSEN-SAVOIE

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	101YP2500X	Professional Counselor	10559	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08906072	OTHER	TX	DRIVERS LICENSE

General Provider Information

NPI Number	:	1871087734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE GAYLE JENSEN-SAVOIE

Provider Business Mailing Address
First Line	:	1301 THROCKMORTON ST APT 1904
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-6318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 THROCKMORTON ST APT 1904
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-6318
Country	:	US
Telephone Number	:	214-793-1947
Fax Number	:

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

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/16/2018

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