| Blue Thistle Psychotherapy, Llc | |
|
1409 Willow St Ste 609 Minneapolis MN 55403-3283 | |
| (651) 212-5205 | |
| (612) 206-9077 |
| Full Name | Blue Thistle Psychotherapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1409 Willow St Ste 609, Minneapolis, Minnesota |
| Authorized Official Name and Position | Josette Wynne (OWNER/SOLE MEMBER) |
| Authorized Official Contact | 6125787916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Thistle Psychotherapy, Llc 1409 Willow St Ste 609 Minneapolis MN 55403-3283 Ph: (651) 212-5205 | Blue Thistle Psychotherapy, Llc 1409 Willow St Ste 609 Minneapolis MN 55403-3283 Ph: (651) 212-5205 |
| NPI Number | 1760247068 |
|---|---|
| Provider Enumeration Date | 02/15/2024 |
| Last Update Date | 02/24/2025 |
| Certification Date | 02/24/2025 |
| Medicare PECOS PAC ID | 0345786737 |
|---|---|
| Medicare Enrollment ID | O20240722002479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760247068 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Josette C Wynne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194486951 PECOS PAC ID: 2163968553 Enrollment ID: I20240722002701 |
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