Provider Demographics
NPI:1588611651
Name:JENSEN, ANDREW LEE (MA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S VIRGINIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-3692
Mailing Address - Country:US
Mailing Address - Phone:270-889-9200
Mailing Address - Fax:270-889-9911
Practice Address - Street 1:1910 S VIRGINIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3692
Practice Address - Country:US
Practice Address - Phone:270-889-9200
Practice Address - Fax:270-889-9911
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1204643OtherCHA PROVIDER NUMBER
TN4035794OtherBCBST PROVIDER NUMBER
LA7628349OtherAETNA PROVIDER NUMBER
KYS85545Medicare UPIN