Active NPI
Michael D Jensen, LCSW BCD
- Clinical Social Worker
- Manti, UT
National Provider Identifier
1124230115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1140763501
- Practice address
- 50 South Main
# 25
Manti, UT 84642 - Phone
- (435) 528-7048
- Fax
- (435) 528-7048
- NPI assigned
- May 4, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1140763501 | UT | Primary |
Addresses
Primary practice location
50 South Main
# 25
Manti, UT 84642
Mailing address
PO Box 936
Gunnison, UT 84634-0936
Phone (435) 528-7048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1140763501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Beginnings Family Counseling | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Health Maintenance Organization
- Manti, UT
- NPI 1487990594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124230115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 936",
"city": "GUNNISON",
"state": "UT",
"postal_code": "846340936",
"telephone_number": "435-528-7048",
"fax_number": "435-528-7048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 SOUTH MAIN",
"address_2": "# 25",
"city": "MANTI",
"state": "UT",
"postal_code": "84642",
"telephone_number": "435-528-7048",
"fax_number": "435-528-7048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "MICHAEL",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "LCSW BCD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "1140763501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manti, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.