Provider Demographics
NPI:1639471048
Name:JENSEN, RANDI JEAN (LMHC, CCDC)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:JEAN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LMHC, CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55967
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-0967
Mailing Address - Country:US
Mailing Address - Phone:206-719-1894
Mailing Address - Fax:206-362-3847
Practice Address - Street 1:20162 6TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1010
Practice Address - Country:US
Practice Address - Phone:206-719-1894
Practice Address - Fax:206-362-3847
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB00025587101YA0400X
WACP00002313101YA0400X
WALH60153692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)