Provider Demographics
NPI:1679659825
Name:THIEMAN, LENNA SUE (MA, LPC-MH, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:LENNA
Middle Name:SUE
Last Name:THIEMAN
Suffix:
Gender:F
Credentials:MA, LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-1794
Mailing Address - Country:US
Mailing Address - Phone:605-842-2284
Mailing Address - Fax:605-842-2284
Practice Address - Street 1:417 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-1794
Practice Address - Country:US
Practice Address - Phone:605-842-2284
Practice Address - Fax:605-842-2284
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDQMHP101YM0800X
SDLPC-MH 2131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD202516515 57580 A001OtherTRICARE/TRIWEST
SD6576070Medicaid
SD12681OtherAVERA HEALTH PLANS
SD4993945OtherWELLMARK BC/BS
SD9234399OtherDAKOTA CARE