=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235456468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE NORTH TREATMENT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2010
-----------------------------------------------------
Last Update Date | 07/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34975 N NORTH VALLEY PKWY SUITE 152
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85086-4028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-849-4887
-----------------------------------------------------
Fax | 888-849-5696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 74695
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85087-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-849-4887
-----------------------------------------------------
Fax | 888-849-5696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. SHONA L SHEWMAKER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 888-849-4887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3944
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3822
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 13421
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------