Provider Demographics
NPI:1700518099
Name:TYLER J JENSEN PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:TYLER J JENSEN PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHC, LMHC, NCC
Authorized Official - Phone:515-779-7169
Mailing Address - Street 1:958 1/2 BALL ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-1507
Mailing Address - Country:US
Mailing Address - Phone:515-779-7169
Mailing Address - Fax:
Practice Address - Street 1:958 1/2 BALL ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-1507
Practice Address - Country:US
Practice Address - Phone:515-779-7169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty