Provider Demographics
NPI:1083777635
Name:JENSEN, JAMES ARNOLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARNOLD
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 W STATE ST APT 305
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2765
Mailing Address - Country:US
Mailing Address - Phone:414-248-1615
Mailing Address - Fax:
Practice Address - Street 1:3800 N MAYFAIR RD
Practice Address - Street 2:LUTHERAN COUNSELING & FAMILY SERVICES
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-536-8333
Practice Address - Fax:414-536-8348
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39105400Medicaid