Active NPI
Judy Ann Tholen, MS, LADC,LPCC
- Mental Health Counselor
- Cass Lake, MN
National Provider Identifier
1548411945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2286
- Practice address
- 16123 Grant Utley Avenue
Cass Lake, MN 56633 - Phone
- (218) 335-3050
- Fax
- (218) 335-4410
- NPI assigned
- Oct 2, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 301820 | MN | |
| Mental Health Counselor | 101YM0800X | 2286 | MN | Primary |
Addresses
Primary practice location
16123 Grant Utley Avenue
Cass Lake, MN 56633
Mailing address
190 Sailstar Dr NE
Cass Lake, MN 56633-3565
Phone (218) 335-3050
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 |
|---|---|---|---|
| 301820 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 2286 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573603200000",
"number": "1548411945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 SAILSTAR DR NE",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "566333565",
"telephone_number": "218-335-3050",
"fax_number": "218-335-4410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16123 GRANT UTLEY AVENUE",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "56633",
"telephone_number": "218-335-3050",
"fax_number": "218-335-4410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOLEN",
"first_name": "JUDY",
"middle_name": "ANN",
"credential": "MS, LADC,LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-02",
"last_updated": "2019-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "301820",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "2286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cass Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.