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General NPI Number Information
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NPI Number | 1508007261
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Entity Type | Organization
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Legal Business Name | TRUE SELF LLC
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 2900 LOUISIANA BLVD. NE SUITE J-1
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3532
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Country | US
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Telephone | 505-639-5772
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Fax | 505-639-5780
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Provider Business Mailing Address
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Address Line | 2900 LOUISIANA BLVD. NE SUITE J-1
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3532
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Country | US
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Telephone | 505-639-5772
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Fax | 505-639-5772
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Authorized Official
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Title or Position | CEO / OWNER / CLINICIAN
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Name | MS. SUZANNE RUSSELL THORNBERRY
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Credential | LCSW
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Telephone | 505-379-3703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I06618
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License Number State | NM
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