Provider Demographics
NPI:1871693457
Name:JENSEN, MARK ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GOUGH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4474
Mailing Address - Country:US
Mailing Address - Phone:415-310-1901
Mailing Address - Fax:415-876-1931
Practice Address - Street 1:414 GOUGH ST STE 6
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4474
Practice Address - Country:US
Practice Address - Phone:415-310-1901
Practice Address - Fax:415-876-1931
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical