Provider Demographics
NPI:1992442180
Name:THIELE, STANLEY FARRELL (LMFT)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:FARRELL
Last Name:THIELE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E DIAMOND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1923
Mailing Address - Country:US
Mailing Address - Phone:612-590-8070
Mailing Address - Fax:
Practice Address - Street 1:8700 W 36TH ST STE 245
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3906
Practice Address - Country:US
Practice Address - Phone:612-590-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist