Provider Demographics
NPI:1417320904
Name:JENSEN, TREY (MA)
Entity Type:Individual
Prefix:MR
First Name:TREY
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-0023
Mailing Address - Country:US
Mailing Address - Phone:763-600-7996
Mailing Address - Fax:
Practice Address - Street 1:200 5TH ST NW STE B
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1917
Practice Address - Country:US
Practice Address - Phone:763-600-7996
Practice Address - Fax:763-244-1243
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6838103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist