Organization
THELEN THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK RODNEY THELEN PSY.D. (LP LICENSED PSYCHOLOGIST)
(763) 370-0243
Entity
Organization
Contact information
Practice address
261 E BROADWAY, TOLLEFSON SUITE, MONTICELLO, MN 55362
(763) 370-0243
Mailing address
PO BOX 102, MONTICELLO, MN 55362-0102
(763) 370-0243
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000693475
—
MN
Enumeration date
11/22/2021
Last updated
11/22/2021
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