Healthcare Provider Details

I. General information

NPI: 1275466914
Provider Name (Legal Business Name): NITAI TRUENORTHCOUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 N NEBULA AVE
STAR ID
83669-5474
US

IV. Provider business mailing address

628 N NEBULA AVE
STAR ID
83669-5474
US

V. Phone/Fax

Practice location:
  • Phone: 805-270-0390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DONNELLE A HAUN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 805-270-0390