Provider Demographics
NPI:1841778131
Name:JENSEN, RIKKI VICTORIA CLEMENS (MA, LPC)
Entity Type:Individual
Prefix:
First Name:RIKKI
Middle Name:VICTORIA CLEMENS
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 N MONACO WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1302
Mailing Address - Country:US
Mailing Address - Phone:208-631-6146
Mailing Address - Fax:
Practice Address - Street 1:1985 N MONACO WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1302
Practice Address - Country:US
Practice Address - Phone:208-631-6146
Practice Address - Fax:208-938-8711
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6169101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor