Provider Demographics
NPI:1316105695
Name:JENSEN, THERESA MICHEL (LPN CAC III)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MICHEL
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LPN CAC III
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MICHEL
Other - Last Name:HUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3168
Mailing Address - Country:US
Mailing Address - Phone:970-522-4549
Mailing Address - Fax:970-522-4211
Practice Address - Street 1:650 EAST WALNUT
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107
Practice Address - Country:US
Practice Address - Phone:303-646-4519
Practice Address - Fax:970-522-4211
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2878101YA0400X
CO15108164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse