Individual
RYAN O THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, LPCC
Contact information
Practice address
2950 XENIUM LN N STE 130, PLYMOUTH, MN 55441-2623
(612) 564-3535
(763) 545-8150
Mailing address
2950 XENIUM LN N STE 130, PLYMOUTH, MN 55441-2623
(612) 564-3535
(763) 545-8150
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
306571
MN
101YM0800X
Mental Health Counselor
Primary
5099
MN
Other
Enumeration date
07/15/2025
Last updated
07/15/2025
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