Provider Demographics
NPI:1497292684
Name:THEOPHILOS, DEAN THEODORE (LPCC, LCPC, LADC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:THEODORE
Last Name:THEOPHILOS
Suffix:
Gender:M
Credentials:LPCC, LCPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 UNIVERSITY AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1854
Mailing Address - Country:US
Mailing Address - Phone:651-641-1009
Mailing Address - Fax:651-789-5677
Practice Address - Street 1:2324 UNIVERSITY AVE W STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1854
Practice Address - Country:US
Practice Address - Phone:651-641-1009
Practice Address - Fax:651-789-5677
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303750101YA0400X
IL180.012732101YM0800X
MNCC01465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)