Active NPI
Thalia Evans
- Behavior Technician
- St Louis Park, MN
National Provider Identifier
1679303663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 5775 Wayzata Blvd Ste 700
St Louis Park, MN 55416-1233 - Phone
- (763) 443-3043
- NPI assigned
- Aug 5, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Occupational Therapist | 225XM0800X | |||
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
5775 Wayzata Blvd Ste 700
St Louis Park, MN 55416-1233
Mailing address
5775 Wayzata Blvd Ste 700
St Louis Park, MN 55416-1233
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1679303663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5775 WAYZATA BLVD STE 700",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5775 WAYZATA BLVD STE 700",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161233",
"telephone_number": "763-443-3043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "THALIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-05",
"last_updated": "2024-08-05",
"certification_date": "2024-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225XM0800X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.