Provider Demographics
NPI:1841663069
Name:JENSEN, IAN CHARLES (LMFT)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:CHARLES
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 GLENDALE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2723
Mailing Address - Country:US
Mailing Address - Phone:323-796-5550
Mailing Address - Fax:323-843-9827
Practice Address - Street 1:2820 GLENDALE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2723
Practice Address - Country:US
Practice Address - Phone:323-796-5550
Practice Address - Fax:323-843-9827
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01536011OtherMEDI-CAL