Provider Demographics
NPI:1962560110
Name:JENSEN, PAUL MARK (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MARK
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 1:315 S 9TH ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2247
Mailing Address - Country:US
Mailing Address - Phone:402-570-7383
Mailing Address - Fax:402-477-8284
Practice Address - Street 1:315 S 9TH ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2247
Practice Address - Country:US
Practice Address - Phone:402-570-7383
Practice Address - Fax:402-477-8284
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE818101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical