Individual
MR. JUSTIN DEAN JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
82 S 800 W, BRIGHAM CITY, UT 84302-2400
(435) 538-5061
Mailing address
PO BOX 526, BRIGHAM CITY, UT 84302-0526
(435) 538-5061
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/17/2010
Last updated
02/16/2011
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