Healthcare Provider Details

I. General information

NPI: 1427731652
Provider Name (Legal Business Name): TRUE NORTH HEALING AND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CAMINO DEL MEDIO
SAN CRISTOBAL NM
87564
US

IV. Provider business mailing address

PO BOX 196
SAN CRISTOBAL NM
87564-0195
US

V. Phone/Fax

Practice location:
  • Phone: 832-609-9113
  • Fax:
Mailing address:
  • Phone: 832-609-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN BROCK ANDERSON
Title or Position: OWNER
Credential: LCSW
Phone: 832-609-9113