Provider Demographics
NPI:1053881284
Name:YENSEN, DEBRA ANN JONES (ATR, LCPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN JONES
Last Name:YENSEN
Suffix:
Gender:F
Credentials:ATR, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-1686
Mailing Address - Country:US
Mailing Address - Phone:208-630-4676
Mailing Address - Fax:
Practice Address - Street 1:1242 HERRICK STREET N
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638
Practice Address - Country:US
Practice Address - Phone:208-630-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional