Healthcare Provider Details

I. General information

NPI: 1295316834
Provider Name (Legal Business Name): AUDREY THIEN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/18/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 S NORTON AVE
SIOUX FALLS SD
57105-3730
US

IV. Provider business mailing address

2109 S NORTON AVE
SIOUX FALLS SD
57105-3730
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-2696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20600
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: