Healthcare Provider Details

I. General information

NPI: 1205543311
Provider Name (Legal Business Name): TRUE SELF COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MIDDLESEX RD
TYNGSBORO MA
01879-1078
US

IV. Provider business mailing address

269 MIDDLESEX RD
TYNGSBORO MA
01879-1078
US

V. Phone/Fax

Practice location:
  • Phone: 978-431-2610
  • Fax:
Mailing address:
  • Phone: 978-431-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARIA LUCCI
Title or Position: MANAGER
Credential: LMHC
Phone: 978-431-2610