Individual
DR. MARK R THELEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD LP LMFT
Contact information
Practice address
261 E BROADWAY ST, MONTICELLO, MN 55362-9317
(763) 370-0243
Mailing address
PO BOX 102, MONTICELLO, MN 55362-0102
(763) 370-0243
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2992
MN
106H00000X
Marriage & Family Therapist
645
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023459
PREFERRED ONE
MN
01
—
105008
UCARE
—
01
—
6118960
UBH
—
01
—
680007902
RR MEDICARE
—
05
—
704817300
—
MN
01
—
7H446TH
BCBS
—
01
—
HP27417
HEALTH PARTNERS
—
Enumeration date
04/07/2006
Last updated
04/21/2021
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