1255662714 NPI number — MICHELE NOEL JENSEN MFT

Table of content: MICHELE NOEL JENSEN MFT (NPI 1255662714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255662714 NPI number — MICHELE NOEL JENSEN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENSEN
Provider First Name:
MICHELE
Provider Middle Name:
NOEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENNETT
Provider Other First Name:
MICHELE
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255662714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 S. CEDROS AVE
Provider Second Line Business Mailing Address:
SUITE #334
Provider Business Mailing Address City Name:
SOLANA BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-518-3415
Provider Business Mailing Address Fax Number:
760-274-6304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 S. CEDROS AVE
Provider Second Line Business Practice Location Address:
SUITE #334
Provider Business Practice Location Address City Name:
SOLANA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-518-3415
Provider Business Practice Location Address Fax Number:
760-274-6304
Provider Enumeration Date:
01/22/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC48059 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 48059 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)