Provider Demographics
NPI:1639644768
Name:JENSEN, LENA MARIE (CP60848776)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:MARIE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:CP60848776
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2506
Mailing Address - Country:US
Mailing Address - Phone:509-477-4622
Mailing Address - Fax:509-477-4635
Practice Address - Street 1:105 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3609
Practice Address - Country:US
Practice Address - Phone:509-570-7250
Practice Address - Fax:509-982-8989
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60848776101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)