MEDICARE: TRUE NORTH COUNSELING SERVICES 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750847851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE NORTH COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	833 WALNUT ST
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-3265
Country	:	US
Telephone Number	:	262-305-8834
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 EAST WATER ST
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-5309
Country	:	US
Telephone Number	:	262-305-8834
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR/OWNER
Name	:	ANDREW B MITCHEL
Credential	:	LPC
Telephone Number	:	262-305-8834

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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