Provider Demographics
NPI:1275973117
Name:JENSEN, ANN MARIE W (LPC, LISAC)
Entity Type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:W
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 E HACKAMORE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5562
Mailing Address - Country:US
Mailing Address - Phone:480-962-8249
Mailing Address - Fax:
Practice Address - Street 1:3063 E HACKAMORE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5562
Practice Address - Country:US
Practice Address - Phone:480-962-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1896101Y00000X
AZ1096101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)