Healthcare Provider Details

I. General information

NPI: 1922343433
Provider Name (Legal Business Name): TRUE NORTH FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-4905
US

IV. Provider business mailing address

8205 SPAIN RD NE SUITE 106
ALBUQUERQUE NM
87109-3179
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-7297
  • Fax:
Mailing address:
  • Phone: 505-804-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0154231
License Number StateNM

VIII. Authorized Official

Name: RHONDA FREEMAN-MAZE
Title or Position: LMHC
Credential:
Phone: 505-804-7297