James Jenkins Theisen, PH.D., LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3639 Issued in MN

Practice address

6 E Diamond Lake Rd
Minneapolis, MN 55419-1923

Phone

(612) 237-2752

NPI assigned

Jul 19, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1689673857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4206 5TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554092120",
            "telephone_number": "612-237-2752",
            "fax_number": "612-237-2752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 E DIAMOND LAKE RD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191923",
            "telephone_number": "612-237-2752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEISEN",
        "first_name": "JAMES",
        "middle_name": "JENKINS",
        "name_prefix": "Dr.",
        "credential": "PH.D., LP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "144M0TH",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "61-78532",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "169040",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katrina Theis, M.A.
• Roberta Jo Theis, MSE
• Brian James Theisen, PT, DPT, ATC
• Calandra D Theisen, DPM
• Jacqueline Theisen, MD, MPH
• Jay Lee Theisen, MSW LICSW
• Joshua William Marvin Theisen, MD-PHD
• Pamela Theisen
• David Thekan
• Emma R Thelen, LICSW

• Clinical Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.