Provider Demographics
NPI:1336886498
Name:JENSEN, KATHERINE LEIGH (CPC-INTERN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LEIGH
Last Name:JENSEN
Suffix:
Gender:
Credentials:CPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N ROOP ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-3107
Mailing Address - Country:US
Mailing Address - Phone:775-393-0544
Mailing Address - Fax:
Practice Address - Street 1:755 N ROOP ST STE 101
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-3107
Practice Address - Country:US
Practice Address - Phone:775-841-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCI5132OtherCLINICAL PROFESSIONAL COUNSELOR INTERN LICENSE