Provider Demographics
NPI:1427542794
Name:JENSEN, JENNIE MICHELLE (LMFT93477)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:MICHELLE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LMFT93477
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:HUGHSON
Mailing Address - State:CA
Mailing Address - Zip Code:95326-9216
Mailing Address - Country:US
Mailing Address - Phone:714-330-5402
Mailing Address - Fax:
Practice Address - Street 1:2825 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326-9216
Practice Address - Country:US
Practice Address - Phone:714-330-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93477106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist