Provider Demographics
NPI:1982276085
Name:JENSEN, BETH REES (RBT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:REES
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 PUUPILO RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-8403
Mailing Address - Country:US
Mailing Address - Phone:808-346-1125
Mailing Address - Fax:
Practice Address - Street 1:3577 LALA RD
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-9520
Practice Address - Country:US
Practice Address - Phone:808-274-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI618822106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician