Individual
DR. JAMES JENKINS THEISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., LP
Contact information
Practice address
6 E DIAMOND LAKE RD, MINNEAPOLIS, MN 55419-1923
(612) 237-2752
Mailing address
4206 5TH AVE S, MINNEAPOLIS, MN 55409-2120
(612) 237-2752
(612) 237-2752
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3639
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
144M0TH
BC/BS
—
01
—
169040
UCARE
—
01
—
61-78532
MEDICA
—
Enumeration date
07/19/2005
Last updated
12/01/2023
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