Marci Marie Mueller Theisen, PSYD, CPRP, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4697 Issued in MN

Practice address

11280 86TH Ave N
Maple Grove, MN 55369-4510

Phone

(763) 400-7828

Fax

(763) 400-7444

NPI assigned

Mar 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Scott M Yarosh, LLC

  • Mental Health Counselor
  • Saint Paul, MN
  • NPI 1144543265
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400803200000",
    "number": "1578697173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11280 86TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694510",
            "telephone_number": "763-400-7828",
            "fax_number": "763-400-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11280 86TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694510",
            "telephone_number": "763-400-7828",
            "fax_number": "763-400-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUELLER THEISEN",
        "first_name": "MARCI",
        "middle_name": "MARIE",
        "credential": "PSYD, CPRP, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2014-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "328687800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H400137396",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Movement Lab Physical Therapy LLC
• Doris Moylan
• Eva Mroczek
• Jeanne D Mrozek, MD
• Papy Muamba
• Hillary Mueller
• John Mueller
• Tamara Mukete, DPT, PT
• Kaushik Mukherjee, DDS
• Elmes K Mulbah

• Clinical Psychologist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.