Provider Demographics
NPI:1255662714
Name:JENSEN, MICHELE NOEL (MFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:NOEL
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:NOEL
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:312 S. CEDROS AVE
Mailing Address - Street 2:SUITE #334
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:619-518-3415
Mailing Address - Fax:760-274-6304
Practice Address - Street 1:312 S. CEDROS AVE
Practice Address - Street 2:SUITE #334
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:619-518-3415
Practice Address - Fax:760-274-6304
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48059106H00000X
CA48059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist