Provider Demographics
NPI:1154565331
Name:THELEN, VERONICA (MS/LLMFT)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:THELEN
Suffix:
Gender:F
Credentials:MS/LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W WALKER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1463
Mailing Address - Country:US
Mailing Address - Phone:989-292-1676
Mailing Address - Fax:
Practice Address - Street 1:5031 PARK LAKE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3835
Practice Address - Country:US
Practice Address - Phone:517-332-0811
Practice Address - Fax:517-332-4452
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist