Provider Demographics
NPI:1700426640
Name:THAYER, FRANK C (LAMFT, LADC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:C
Last Name:THAYER
Suffix:
Gender:M
Credentials:LAMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11424 KELL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3539
Mailing Address - Country:US
Mailing Address - Phone:952-686-3606
Mailing Address - Fax:
Practice Address - Street 1:3701 SHORELINE DR STE 102A
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4000
Practice Address - Country:US
Practice Address - Phone:952-314-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty