Provider Demographics
NPI:1306426895
Name:JENSEN, JAMES DAVID (LPC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:DAVID
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2807 W GEM ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1732
Mailing Address - Country:US
Mailing Address - Phone:208-861-6643
Mailing Address - Fax:
Practice Address - Street 1:2807 W GEM ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1732
Practice Address - Country:US
Practice Address - Phone:208-861-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional