Basic Information
| Provider Information | |||||||||
| NPI: | 1831495639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | MARILEE | ||||||||
| MiddleName: | HAWKINS | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1864 N 400 W | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840572140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013766578 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1384 W STATE RD | ||||||||
| Address2: | SUITE 24 | ||||||||
| City: | PLEASANT GROVE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840624130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013736562 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2011 | ||||||||
| LastUpdateDate: | 10/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6794367-6004 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.