Provider Demographics
NPI:1578174447
Name:JENSEN, BROOKE (LPCP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-8051
Mailing Address - Country:US
Mailing Address - Phone:708-308-3164
Mailing Address - Fax:
Practice Address - Street 1:525 E NORTH ST STE F
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1186
Practice Address - Country:US
Practice Address - Phone:708-308-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014365101YP2500X
IL180013830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional