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NPI Code Detail

MEDICARE: DR. MARK R THELEN PSYD LP LMFT

MEDICARE: DR. MARK R THELEN PSYD LP LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist645MN
2103T00000XPsychologistLP2992MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5680007902OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16118960OTHERUBH
2105008OTHERUCARE
3HP27417OTHERHEALTH PARTNERS
41023459OTHERMNPREFERRED ONE
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
77H446THOTHERBCBS

General Provider Information

NPI Number : 1568425908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK R THELEN PSYD LP LMFT
Provider Business Mailing Address
First Line : PO BOX 102
Second Line :
City : MONTICELLO
State : MN
Zip : 55362-0102
Country : US
Telephone Number : 763-370-0243
Fax Number :
Provider Business Practice Location Address
First Line : 261 E BROADWAY ST
Second Line :
City : MONTICELLO
State : MN
Zip : 55362-9317
Country : US
Telephone Number : 763-370-0243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 04/21/2021

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