Provider Demographics
NPI:1558864124
Name:JENSEN, DARCY LEE (LAC, MAC, CPS)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:LEE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LAC, MAC, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 EAST 41ST STREET
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SOUIX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-331-5724
Mailing Address - Fax:605-331-5725
Practice Address - Street 1:822 EAST 41ST. STREET
Practice Address - Street 2:SUITE 235
Practice Address - City:SOUIX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-331-5724
Practice Address - Fax:605-331-5725
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD510956101YA0400X
SD700156405300000X
SD9707960101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional