Provider Demographics
NPI:1558082578
Name:REBEKAH N. JENSEN LCSW LLC
Entity Type:Organization
Organization Name:REBEKAH N. JENSEN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-975-1040
Mailing Address - Street 1:13751 HILL CREST CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9143
Mailing Address - Country:US
Mailing Address - Phone:317-975-1040
Mailing Address - Fax:
Practice Address - Street 1:13751 HILL CREST CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9143
Practice Address - Country:US
Practice Address - Phone:317-975-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679971253OtherINDIVIDUAL NPI
IN34007622AOtherINDIANA LCSW STATE LICENSE
IL149.018916OtherILLINOIS LCSW STATE LICENSE