Provider Demographics
NPI:1043616857
Name:JENSEN, KALA (MS, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MS, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 SE MCGILLIVRAY BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3485
Mailing Address - Country:US
Mailing Address - Phone:360-209-4151
Mailing Address - Fax:360-838-0410
Practice Address - Street 1:16701 SE MCGILLIVRAY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3485
Practice Address - Country:US
Practice Address - Phone:360-209-4151
Practice Address - Fax:360-838-0410
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60503079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health