Provider Demographics
NPI:1427491943
Name:JENSEN, LEA (BS IN LEADERSHIP)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:BS IN LEADERSHIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1004
Mailing Address - Country:US
Mailing Address - Phone:405-503-6529
Mailing Address - Fax:
Practice Address - Street 1:3923 N PENN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7566
Practice Address - Country:US
Practice Address - Phone:405-424-0007
Practice Address - Fax:405-605-0599
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health