Provider Demographics
NPI:1093954919
Name:JENSEN, ANNA LISA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LISA
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LISA
Other - Last Name:HINNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 SOVEREIGN CT
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4441
Mailing Address - Country:US
Mailing Address - Phone:314-422-9924
Mailing Address - Fax:
Practice Address - Street 1:301 SOVEREIGN CT
Practice Address - Street 2:SUITE 211
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4441
Practice Address - Country:US
Practice Address - Phone:314-422-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009000728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional