MEDICARE: TRUE CONNECTIONS OF SOUTHERN CALIFORNIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1023771110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE CONNECTIONS OF SOUTHERN CALIFORNIA, LLC

Provider Business Mailing Address
First Line	:	23502 MAGIC MOUNTAIN PKWY APT 1511
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91355-1312
Country	:	US
Telephone Number	:	213-275-6786
Fax Number	:

Provider Business Practice Location Address
First Line	:	23502 MAGIC MOUNTAIN PKWY APT 1511
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1312
Country	:	US
Telephone Number	:	213-275-6786
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. THOMAS DVORAK
Credential	:
Telephone Number	:	213-275-6786

Provider Enumeration Date	:	10/16/2021
Last Update Date	:	10/16/2021

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