Provider Demographics
NPI:1306986013
Name:JENSEN, DAVID BLAINE (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BLAINE
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84754-3119
Mailing Address - Country:US
Mailing Address - Phone:435-201-9228
Mailing Address - Fax:435-896-8769
Practice Address - Street 1:991 S 100 E
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-7030
Practice Address - Country:US
Practice Address - Phone:435-201-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14157635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical