Active NPI
Glynis N Thiesse, MS LP
- Clinical Psychologist
- Brainerd, MN
National Provider Identifier
1376559716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4630
- Practice address
- 617 Oak St
Brainerd, MN 56401-3610 - Phone
- (218) 829-7140
- NPI assigned
- Jul 31, 2006
- Last updated
- Jul 9, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4630 | MN | Primary |
Addresses
Primary practice location
617 Oak St
Brainerd, MN 56401-3610
Mailing address
617 Oak St
Brainerd, MN 56401-3610
Phone (218) 829-7140
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6281371 | Other | MN | MEDICA |
| 62G75TH | Other | MN | BCBS |
| 115826 | Other | MN | 115826 |
| 848980 | Other | MN | ARAZ |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4630 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Core Professional Services, P.a. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1376559716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 OAK ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013610",
"telephone_number": "218-829-7140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 OAK ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013610",
"telephone_number": "218-829-7140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIESSE",
"first_name": "GLYNIS",
"middle_name": "N",
"credential": "MS LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "4630",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "6281371",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "62G75TH",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "115826",
"identifier": "115826",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "848980",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brainerd, MN
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- The Therapist (The Therapist PLC)
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- Theraspire Counseling Services, PLLC
- Jenah Thomas, RN
- Jennifer Ann Thomas, MS, LPCC
- Thompson Real Estate Company, LLC (Tree Of Life Holistic)
- Cameron Alan Thompson, MT
- Megan Elizabeth Thompson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.