Provider Demographics
NPI:1225584592
Name:JENSEN, ANITA CHRISTINE (LPPC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CHRISTINE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 WESTPARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053
Mailing Address - Country:US
Mailing Address - Phone:440-989-4987
Mailing Address - Fax:440-282-4779
Practice Address - Street 1:2115 WESTPARK DRIVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-989-4987
Practice Address - Fax:440-282-4779
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional