Provider Demographics
NPI:1770076424
Name:JENSEN, ERIK (MA, LPC)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 WESTWOOD MAIN DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-2609
Mailing Address - Country:US
Mailing Address - Phone:979-492-2782
Mailing Address - Fax:
Practice Address - Street 1:1920 W VILLA MARIA RD STE 304A
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-4864
Practice Address - Country:US
Practice Address - Phone:979-492-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76166101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor