Active NPI
Lisa Kristine Jensen, PH.D.
- Clinical Psychologist
- La Jolla, CA
National Provider Identifier
1659759355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 16103
- Practice address
- 3252 Holiday CT Ste 201
La Jolla, CA 92037-1808 - Phone
- (619) 354-7400
- Fax
- (619) 574-6964
- NPI assigned
- May 13, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 Psychologist | 103TC0700X | 16103 | CA | Primary |
Addresses
Primary practice location
3252 Holiday CT Ste 201
La Jolla, CA 92037-1808
Mailing address
3252 Holiday CT Ste 201
La Jolla, CA 92037-1808
Phone (619) 354-7400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 11, 2023 through Dec 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16103 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552521600000",
"number": "1659759355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3252 HOLIDAY CT STE 201",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920371808",
"telephone_number": "619-354-7400",
"fax_number": "619-574-6964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3252 HOLIDAY CT STE 201",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920371808",
"telephone_number": "619-354-7400",
"fax_number": "619-574-6964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "LISA",
"middle_name": "KRISTINE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-13",
"last_updated": "2019-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "16103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.