Basic Information
| Provider Information | |||||||||
| NPI: | 1548490089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | TAMMIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W NORFOLK AVE | ||||||||
| Address2: | STE. 201 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023792030 | ||||||||
| FaxNumber: | 4023793933 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W NORFOLK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023703140 | ||||||||
| FaxNumber: | 4023703373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2009 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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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 | 101YM0800X | 3667 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | P-897 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 391894354 | 05 | NE | MEDICAID |