Provider Demographics
NPI:1184914954
Name:MARTEEN JENSEN, LPC, PC
Entity type:Organization
Organization Name:MARTEEN JENSEN, LPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-491-0811
Mailing Address - Street 1:510 NE ROBERTS AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7486
Mailing Address - Country:US
Mailing Address - Phone:503-491-0811
Mailing Address - Fax:503-491-0462
Practice Address - Street 1:510 NE ROBERTS AVE STE 350
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7486
Practice Address - Country:US
Practice Address - Phone:503-491-0811
Practice Address - Fax:503-491-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1184251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health