Healthcare Provider Details

I. General information

NPI: 1467808212
Provider Name (Legal Business Name): TRUE DIFFERENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 E LARKSPUR DR
SCOTTSDALE AZ
85260-5145
US

IV. Provider business mailing address

9855 E LARKSPUR DR
SCOTTSDALE AZ
85260-5145
US

V. Phone/Fax

Practice location:
  • Phone: 480-329-5636
  • Fax: 480-247-5387
Mailing address:
  • Phone: 480-329-5636
  • Fax: 480-247-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC11162
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3499
License Number StateAZ

VIII. Authorized Official

Name: DR. DANIEL NEWTON SHORT
Title or Position: MANAGER
Credential: PHD
Phone: 480-329-5359