Provider Demographics
NPI:1730507641
Name:JENSON, CAROLYN ASHLEY (PCC, LMFT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ASHLEY
Last Name:JENSON
Suffix:
Gender:F
Credentials:PCC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2026
Mailing Address - Country:US
Mailing Address - Phone:216-453-1112
Mailing Address - Fax:216-362-6643
Practice Address - Street 1:1225 ORLEN AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2955
Practice Address - Country:US
Practice Address - Phone:330-945-4944
Practice Address - Fax:330-945-4955
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800205-CR101Y00000X
OHM0900016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist