Provider Demographics
NPI:1679127633
Name:JENSEN, TYLER JAMES (MS, LCMHC, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MS, LCMHC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 WILLS GROVE LN APT 106
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-8078
Mailing Address - Country:US
Mailing Address - Phone:515-779-7169
Mailing Address - Fax:
Practice Address - Street 1:612 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8506
Practice Address - Country:US
Practice Address - Phone:515-779-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15036101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor