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General NPI Number Information
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NPI Number | 1760247068
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Entity Type | Organization
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Legal Business Name | BLUE THISTLE PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1409 WILLOW ST STE 609
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3283
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Country | US
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Telephone | 651-212-5205
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Fax | 612-206-9077
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Provider Business Mailing Address
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Address Line | 1409 WILLOW ST STE 609
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3283
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Country | US
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Telephone | 651-212-5205
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Fax | 612-206-9077
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | JOSETTE WYNNE
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Credential | MSW
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Telephone | 612-578-7916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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