Provider Demographics
NPI:1841264082
Name:JENSEN, KATHY F (LCSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:F
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 NEVADA HIGHWAY
Mailing Address - Street 2:#3
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005
Mailing Address - Country:US
Mailing Address - Phone:702-294-2866
Mailing Address - Fax:702-294-3073
Practice Address - Street 1:916 NEVADA HIGHWAY
Practice Address - Street 2:#3
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005
Practice Address - Country:US
Practice Address - Phone:702-294-2866
Practice Address - Fax:702-294-3073
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2678C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
38646Medicare PIN
38648Medicare PIN