Provider Demographics
NPI:1902463813
Name:JENSEN, AUGUST (MA, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MA, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:TROUT LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98650-0360
Mailing Address - Country:US
Mailing Address - Phone:541-716-1520
Mailing Address - Fax:
Practice Address - Street 1:708 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1720
Practice Address - Country:US
Practice Address - Phone:541-716-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61225574101YP2500X
ORC6158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional