Provider Demographics
NPI:1821469156
Name:JORGENSEN, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 YORKTOWN DR STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3673
Mailing Address - Country:US
Mailing Address - Phone:318-542-4288
Mailing Address - Fax:318-704-6201
Practice Address - Street 1:109 YORKTOWN DR STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3673
Practice Address - Country:US
Practice Address - Phone:318-542-4288
Practice Address - Fax:318-704-6201
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health