Individual
NICHOLAS THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA LADC
Contact information
Practice address
2311 WOODBRIDGE ST, ROSEVILLE, MN 55113-4710
(651) 773-0832
Mailing address
2311 WOODBRIDGE ST, ROSEVILLE, MN 55113-4710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303546
MN
Other
Enumeration date
12/13/2017
Last updated
12/13/2017
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