Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY0851 | NV |
Y | 103T00000X | Psychologist | PY0851 | NV |
N | 103TC1900X | Counseling Psychologist | 2585 | CO |
NPI | 1063637486 |
---|---|
Provider Name | Dr. Laura Lea Jensen |
First Address | Las Vegas, NV 89144-6631 |
Second Address | Las Vegas, NV 89134-8312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2585 | LICENSE NUMBER (01) | CO |
PY0851 | LICENSE NUMBER (01) | NV |