Provider Demographics
NPI:1548411945
Name:THOLEN, JUDY ANN (MS, LADC,LPCC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:THOLEN
Suffix:
Gender:F
Credentials:MS, LADC,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SAILSTAR DR NE
Mailing Address - Street 2:
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-3565
Mailing Address - Country:US
Mailing Address - Phone:218-335-3050
Mailing Address - Fax:218-335-4410
Practice Address - Street 1:16123 GRANT UTLEY AVENUE
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:218-335-3050
Practice Address - Fax:218-335-4410
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301820101YA0400X
MN2286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)