Individual provider Active NPI

Stanley Farrell Thiele, LMFT

  • Marriage & Family Therapist
  • St Louis Park, MN
National Provider Identifier
1992442180
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
8700 W 36TH St Ste 245
Saint Louis Park, MN 55426-3906
Phone
(612) 590-8070
NPI assigned
May 18, 2022
Last updated
May 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MN Primary

Addresses

Primary practice location

8700 W 36TH St Ste 245
Saint Louis Park, MN 55426-3906

Mailing address

6 E Diamond Lake Rd
Minneapolis, MN 55419-1923
Phone (612) 590-8070

Other practice location 1

6 E Diamond Lake Rd
Minneapolis, MN 55419-1923
Phone (612) 590-8070

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240706000243 MN Practitioner - Marriage and Family Therapist 9133663743 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Interpersonal Mental Health LLC Marriage & Family Therapist CurrentSince May 1, 2024 Accepting new patients

Locations

6 E Diamond Lake Rd
Minneapolis, MN 55419
Phone (612) 237-2752

8700 W 36th St
Ste 245
Saint Louis Park, MN 55426
Phone (612) 590-8070

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1992442180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 E DIAMOND LAKE RD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191923",
            "telephone_number": "612-590-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 W 36TH ST STE 245",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554263906",
            "telephone_number": "612-590-8070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 E Diamond Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554191923",
            "country_code": "US",
            "telephone_number": "612-590-8070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIELE",
        "first_name": "STANLEY",
        "middle_name": "FARRELL",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-18",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.