Provider Demographics
NPI:1932622321
Name:JENSEN, JARED (LMFT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MALL DR STE I102
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7322
Mailing Address - Country:US
Mailing Address - Phone:435-429-1032
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE I102
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7322
Practice Address - Country:US
Practice Address - Phone:435-429-1032
Practice Address - Fax:435-429-1032
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8211279-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist