Healthcare Provider Details

I. General information

NPI: 1265194146
Provider Name (Legal Business Name): TRUE NORTH PSYCHOTHERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 SAN RAFAEL AVE NE
ALBUQUERQUE NM
87122-1133
US

IV. Provider business mailing address

PO BOX 1602
TIJERAS NM
87059-1602
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-9742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LORA BLAZINA
Title or Position: DIRECTOR
Credential:
Phone: 505-382-9742