Provider Demographics
NPI:1063637486
Name:JENSEN, LAURA LEA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEA
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:JENSEN
Other - Last Name:GUARNERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9213 LAS MANAITAS AVE UNIT 401
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6631
Mailing Address - Country:US
Mailing Address - Phone:702-498-0871
Mailing Address - Fax:
Practice Address - Street 1:9414 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8312
Practice Address - Country:US
Practice Address - Phone:702-498-0871
Practice Address - Fax:702-445-6434
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2585103TC1900X
NVPY0851103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPY0851OtherLICENSE NUMBER
CO2585OtherLICENSE NUMBER