Provider Demographics
NPI:1225248370
Name:JENSEN, LAURIE ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 LAKE EARL DR
Mailing Address - Street 2:PO BOX 7000
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95532-0001
Mailing Address - Country:US
Mailing Address - Phone:707-465-1000
Mailing Address - Fax:707-465-9107
Practice Address - Street 1:2596 N STOKESBERRY PL STE 125
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6432
Practice Address - Country:US
Practice Address - Phone:208-448-9575
Practice Address - Fax:208-898-8838
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical