Provider Demographics
NPI:1366649428
Name:THEISEN, SCOTT (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:THEISEN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 ASBURY RD
Mailing Address - Street 2:SUITE 777
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2971
Mailing Address - Country:US
Mailing Address - Phone:563-556-9642
Mailing Address - Fax:563-557-5030
Practice Address - Street 1:2728 ASBURY RD
Practice Address - Street 2:SUITE 777
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2971
Practice Address - Country:US
Practice Address - Phone:563-556-9642
Practice Address - Fax:563-557-5030
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health