Provider Demographics
NPI:1255545851
Name:JENSEN, MOGENS REIMER (PHD)
Entity type:Individual
Prefix:DR
First Name:MOGENS
Middle Name:REIMER
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 1:300 COLONIAL CENTER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4892
Mailing Address - Country:US
Mailing Address - Phone:770-640-1650
Mailing Address - Fax:
Practice Address - Street 1:300 COLONIAL CENTER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4892
Practice Address - Country:US
Practice Address - Phone:770-640-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001343103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist