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Individual

PAUL JOHN THINESEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA LP BCBA

Contact information

Practice address
2565 MORNINGSIDE RD, LONG LAKE, MN 55356-9109
(651) 263-0763
Mailing address
2565 MORNINGSIDE RD, LONG LAKE, MN 55356-9109
(651) 263-0763

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0762
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
191308
VALUEOPTIONS ID
MN
05
232850000
MN
01
6190806
MEDICA
MN
01
84G16TH
BCBS
MN
Enumeration date
11/09/2006
Last updated
05/18/2010
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