Provider Demographics
NPI:1649937996
Name:THELEN THERAPY SERVICES LLC
Entity type:Organization
Organization Name:THELEN THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LP LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:THELEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:763-370-0243
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-0102
Mailing Address - Country:US
Mailing Address - Phone:763-370-0243
Mailing Address - Fax:
Practice Address - Street 1:261 E BROADWAY
Practice Address - Street 2:TOLLEFSON SUITE
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362
Practice Address - Country:US
Practice Address - Phone:763-370-0243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1000693475Medicaid