Provider Demographics
NPI:1881261758
Name:THIEL, MADELINE R (BT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:R
Last Name:THIEL
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 ORANGE GROVE PL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-6745
Mailing Address - Country:US
Mailing Address - Phone:760-215-2320
Mailing Address - Fax:
Practice Address - Street 1:2226 ORANGE GROVE PL
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-6745
Practice Address - Country:US
Practice Address - Phone:760-215-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty