Doctor Name: | MR. MICHAEL D JENSEN |
NPI Number: | 1124230115 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW BCD |
License Number: | 1140763501 |
Business Practice Address: | 50 South Main # 25 Manti, UT - 84642 |
Business Phone Number: | 4355287048 |
Business Fax Number: | 4355287048 |
Mailing Address: | Po Box 936, GUNNISON |
State: | UT |
Postal Code: | 846340936 |
Phone Number: | 4355287048 |
Fax Number: | 4355287048 |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 1140763501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |