Provider Demographics
NPI:1922213438
Name:JENSEN, JAY PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:PAUL
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3417
Mailing Address - Country:US
Mailing Address - Phone:801-377-9660
Mailing Address - Fax:801-377-5050
Practice Address - Street 1:811 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3417
Practice Address - Country:US
Practice Address - Phone:801-377-9660
Practice Address - Fax:801-377-5050
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114196-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical