Provider Demographics
NPI:1669839239
Name:HENSLIN, JASON (LAC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HENSLIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16838 E PALISADES BLVD
Mailing Address - Street 2:C-153
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3786
Mailing Address - Country:US
Mailing Address - Phone:480-861-0020
Mailing Address - Fax:
Practice Address - Street 1:16838 E PALISADES BLVD
Practice Address - Street 2:C-153
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3786
Practice Address - Country:US
Practice Address - Phone:480-861-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-5625T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional