Provider Demographics
NPI:1457495954
Name:JENSEN, MARTEEN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARTEEN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NE ROBERTS AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7486
Mailing Address - Country:US
Mailing Address - Phone:502-419-0811
Mailing Address - Fax:
Practice Address - Street 1:510 NE ROBERTS AVE STE 350
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7486
Practice Address - Country:US
Practice Address - Phone:502-419-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional