Provider Demographics
NPI:1366175812
Name:THIELEN, SCOTT PHILLIP
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:PHILLIP
Last Name:THIELEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 RIDGEWATER LN APT SUITE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1346
Mailing Address - Country:US
Mailing Address - Phone:858-722-2874
Mailing Address - Fax:
Practice Address - Street 1:226 W OJAI AVE
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3277
Practice Address - Country:US
Practice Address - Phone:805-245-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist