Provider Demographics
NPI:1245923341
Name:THIELE, BETH (TLLP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:THIELE
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 W RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4116
Mailing Address - Country:US
Mailing Address - Phone:906-458-2141
Mailing Address - Fax:
Practice Address - Street 1:102 W WASHINGTON ST STE 106
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4350
Practice Address - Country:US
Practice Address - Phone:906-228-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009409103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling