Individual
MARCI MARIE MUELLER THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, CPRP, LP
Contact information
Practice address
11280 86TH AVE N, MAPLE GROVE, MN 55369-4510
(763) 400-7828
(763) 400-7444
Mailing address
11280 86TH AVE N, MAPLE GROVE, MN 55369-4510
(763) 400-7828
(763) 400-7444
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4697
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328687800
—
MN
01
—
H400137396
MEDICARE PTAN
MN
Enumeration date
03/15/2007
Last updated
05/23/2014
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