Active NPI
Tessa Rose Thulien, LPC
- Mental Health Counselor
- Boulder, CO
National Provider Identifier
1184872251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC.0012630
- Practice address
- 1333 Iris Ave
Boulder, CO 80304-2226 - Phone
- (303) 413-6289
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178005203 | IL | |
| Professional Counselor | 101YP2500X | 180.007439 | IL | |
| Mental Health Counselor | 101YM0800X | LPC.0012630 | CO | Primary |
Addresses
Primary practice location
1333 Iris Ave
Boulder, CO 80304-2226
Mailing address
1333 Iris Ave
Boulder, CO 80304-2226
Phone (303) 413-6289
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC.0012630 | CO | MD | Mental Health Counselor |
| 178005203 | IL | MD | Professional Counselor |
| 180.007439 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460419200000",
"number": "1184872251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1333 IRIS AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803042226",
"telephone_number": "303-413-6289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 IRIS AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803042226",
"telephone_number": "303-413-6289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THULIEN",
"first_name": "TESSA",
"middle_name": "ROSE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-03",
"last_updated": "2016-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178005203",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.007439",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "LPC.0012630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.