Provider Demographics
NPI:1659739803
Name:JENSEN, DANIEL B (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 S 3050 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5540
Mailing Address - Country:US
Mailing Address - Phone:385-448-7777
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4014
Practice Address - Country:US
Practice Address - Phone:801-804-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8349329-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical