Provider Demographics
NPI:1417225012
Name:JENSEN, DAVID W (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6436 S 5180 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3812
Mailing Address - Country:US
Mailing Address - Phone:801-916-0701
Mailing Address - Fax:
Practice Address - Street 1:6436 S 5180 W
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-3812
Practice Address - Country:US
Practice Address - Phone:801-916-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5714096-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health