Individual
MS. KRISTINE A. THELEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
108 N MAIN ST, SUITE 305, SOUTH BEND, IN 46601-1625
(574) 234-3515
(574) 234-3565
Mailing address
4209 CROSS CREEK DR, SOUTH BEND, IN 46628
(574) 261-2488
(574) 234-3565
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
34004344A
IN
Other
Enumeration date
07/20/2005
Last updated
07/08/2007
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