Provider Demographics
NPI:1861533465
Name:JENSEN, TRISHA TAGE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:TAGE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84150-0001
Mailing Address - Country:US
Mailing Address - Phone:801-541-4944
Mailing Address - Fax:
Practice Address - Street 1:94 E PAGES LN
Practice Address - Street 2:SUITE A
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2216
Practice Address - Country:US
Practice Address - Phone:801-294-0578
Practice Address - Fax:801-298-2147
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6364085-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical