Provider Demographics
NPI:1750416954
Name:JENSEN, FLOYD JAMES III (PSYD)
Entity type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:JAMES
Last Name:JENSEN
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RIVER RUN
Mailing Address - Street 2:SUITE 404
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6579
Mailing Address - Country:US
Mailing Address - Phone:817-332-8002
Mailing Address - Fax:
Practice Address - Street 1:1701 RIVER RUN
Practice Address - Street 2:SUITE 404
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6579
Practice Address - Country:US
Practice Address - Phone:817-332-8002
Practice Address - Fax:817-332-8063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611077Medicare ID - Type UnspecifiedPROVIDER NUMBER