Healthcare Provider Details

I. General information

NPI: 1639857410
Provider Name (Legal Business Name): TRUE NORTH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 NE HOOD AVE
GRESHAM OR
97030-7328
US

IV. Provider business mailing address

657 NE HOOD AVE
GRESHAM OR
97030-7328
US

V. Phone/Fax

Practice location:
  • Phone: 971-367-0841
  • Fax:
Mailing address:
  • Phone: 971-367-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANNELISE M MANNS
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 971-367-0841