Provider Demographics
NPI:1023176708
Name:JENSEN, CARLA (PHD, LCSW MFT)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHD, LCSW MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 S OLD QUARRY WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0541
Mailing Address - Country:US
Mailing Address - Phone:208-914-0877
Mailing Address - Fax:208-429-8510
Practice Address - Street 1:198 S OLD QUARRY WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0541
Practice Address - Country:US
Practice Address - Phone:208-914-0877
Practice Address - Fax:208-321-2773
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-2911106H00000X
IDLCSW-246291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDL3928OtherBLUE CROSS OF IDAHO
ID000010147740OtherREGENCE BLUE SHIELD