Healthcare Provider Details

I. General information

NPI: 1235456468
Provider Name (Legal Business Name): TRUE NORTH TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34975 N NORTH VALLEY PKWY SUITE 152
PHOENIX AZ
85086-4028
US

IV. Provider business mailing address

PO BOX 74695
PHOENIX AZ
85087-1012
US

V. Phone/Fax

Practice location:
  • Phone: 888-849-4887
  • Fax: 888-849-5696
Mailing address:
  • Phone: 888-849-4887
  • Fax: 888-849-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number13421
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3944
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3822
License Number StateAZ

VIII. Authorized Official

Name: DR. SHONA L SHEWMAKER
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 888-849-4887