Provider Demographics
NPI:1629512843
Name:JENSEN, ERNIE RAY (LMHCA)
Entity Type:Individual
Prefix:
First Name:ERNIE
Middle Name:RAY
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:E.
Other - Middle Name:RAY
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHCA
Mailing Address - Street 1:11105 NE 14TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4308
Mailing Address - Country:US
Mailing Address - Phone:360-953-0915
Mailing Address - Fax:
Practice Address - Street 1:5000 NE 72ND AVE
Practice Address - Street 2:APT 30
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-8166
Practice Address - Country:US
Practice Address - Phone:360-953-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60627105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health