Provider Demographics
NPI:1134560253
Name:KATE JENSEN LCSW
Entity type:Organization
Organization Name:KATE JENSEN LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN HINCHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:850-984-5283
Mailing Address - Street 1:1509 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:PANACEA
Mailing Address - State:FL
Mailing Address - Zip Code:32346-2159
Mailing Address - Country:US
Mailing Address - Phone:850-984-5283
Mailing Address - Fax:850-984-4467
Practice Address - Street 1:1509 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:PANACEA
Practice Address - State:FL
Practice Address - Zip Code:32346-2159
Practice Address - Country:US
Practice Address - Phone:850-984-5283
Practice Address - Fax:850-984-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 82731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty