Individual
DR. CARLA JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LCSW MFT
Contact information
Practice address
198 S OLD QUARRY WAY, BOISE, ID 83709-0541
(208) 914-0877
(208) 321-2773
Mailing address
198 S OLD QUARRY WAY, BOISE, ID 83709-0541
(208) 914-0877
(208) 429-8510
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-24629
ID
106H00000X
Marriage & Family Therapist
LMFT-2911
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147740
REGENCE BLUE SHIELD
ID
01
—
L3928
BLUE CROSS OF IDAHO
ID
Enumeration date
12/05/2006
Last updated
10/03/2023
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