MEDICARE: TRUE SELF MENTAL WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1366329369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE SELF MENTAL WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1820 E RAY RD UNIT 2004
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-8720
Country	:	US
Telephone Number	:	414-708-4615
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 W RAY RD
Second Line	:	SUITE 6&7
City	:	CHANDLER
State	:	AZ
Zip	:	85225
Country	:	US
Telephone Number	:	480-331-9140
Fax Number	:	480-383-6596

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	THOMAS MARTIN
Credential	:	PA
Telephone Number	:	414-708-4615

Provider Enumeration Date	:	08/20/2025
Last Update Date	:	03/06/2026

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