Jacqueline Marie Theisen, NCC, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC00794 Issued in MN

Practice address

225 3Rd Ave NW
Hutchinson, MN 55350-1623

Phone

(320) 455-9888

Fax

(320) 587-5390

NPI assigned

Aug 15, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jacqui Ruzicka Counseling Services, LLC

  • Community/Behavioral Health Agency
  • Hutchinson, MN
  • NPI 1669849808
  Medicare reassignment NPD Authorized official
• True Balance LTD

  • Multi-Specialty Clinic/Center
  • Little Falls, MN
  • NPI 1205025442
  NPD (past)

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

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1962835777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 3RD AVE NW",
            "city": "HUTCHINSON",
            "state": "MN",
            "postal_code": "553501623",
            "telephone_number": "320-455-9888",
            "fax_number": "320-587-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 3RD AVE NW",
            "city": "HUTCHINSON",
            "state": "MN",
            "postal_code": "553501623",
            "telephone_number": "320-455-9888",
            "fax_number": "320-587-5390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Broadway St",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "MN",
            "postal_code": "553629353",
            "country_code": "US",
            "telephone_number": "763-272-1544",
            "fax_number": "320-310-0983",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEISEN",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "credential": "NCC, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-15",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "284917",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC00794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leann F Sundhagen, OD
• Sigrid Szafranski, LPN
• Sherry Tauer-Nere
• Tenequa Shakell Terry, RN
• Theis Family Dental, PLLC
• Kate Theisen, M.S. CF SLP
• Timothy Richard Theisen, PTA
• Thomas L Price Associates
• Beverly Ann Thomas, RN
• Elizabeth Thompson, PTA

• Mental Health Counselor in Hutchinson, MN
• Providers in Hutchinson, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.