Doctor Name: | DENISE MARIE JENSEN |
NPI Number: | 1346503877 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LPC-4914 |
Business Practice Address: | 215 University Dr Gooding, ID - 833306155 |
Business Phone Number: | 2089345880 |
Business Fax Number: | 2089345876 |
Mailing Address: | 1405 Heyburn Ave E, TWIN FALLS |
State: | ID |
Postal Code: | 833014856 |
Phone Number: | 2083391756 |
Fax Number: | |
NPI Enumeration Date: | 06/19/2012 |
NPI Last Update Date: | 06/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-4914 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |