Provider Demographics
NPI:1831495639
Name:JENSEN, MARILEE HAWKINS (LPC)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:HAWKINS
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 N 400 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2140
Mailing Address - Country:US
Mailing Address - Phone:801-376-6578
Mailing Address - Fax:
Practice Address - Street 1:1384 W STATE RD
Practice Address - Street 2:SUITE 24
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4130
Practice Address - Country:US
Practice Address - Phone:801-373-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6794367-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional