Provider Demographics
NPI:1780314237
Name:JENSEN, CASSIDY
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:JENSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E CREEKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-9269
Mailing Address - Country:US
Mailing Address - Phone:785-201-4666
Mailing Address - Fax:
Practice Address - Street 1:1221 N ROCK RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3678
Practice Address - Country:US
Practice Address - Phone:316-747-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KSLCPC03919101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health