Healthcare Provider Details

I. General information

NPI: 1366329369
Provider Name (Legal Business Name): TRUE SELF MENTAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W RAY RD STE 6&7
CHANDLER AZ
85225-7284
US

IV. Provider business mailing address

501 W RAY RD STE 6&7
CHANDLER AZ
85225-7284
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-9140
  • Fax: 480-383-6596
Mailing address:
  • Phone: 480-331-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MARTIN
Title or Position: MANAGING MEMBER
Credential: PA
Phone: 414-708-4615