MEDICARE: TRUE SELF 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	1041C0700X	Clinical Social Worker	I06618	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508007261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE SELF LLC

Provider Business Mailing Address
First Line	:	2900 LOUISIANA BLVD. NE
Second Line	:	SUITE J-1
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3532
Country	:	US
Telephone Number	:	505-639-5772
Fax Number	:	505-639-5772

Provider Business Practice Location Address
First Line	:	2900 LOUISIANA BLVD. NE
Second Line	:	SUITE J-1
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3532
Country	:	US
Telephone Number	:	505-639-5772
Fax Number	:	505-639-5780

Authorized Official
Title or Position	:	CEO / OWNER / CLINICIAN
Name	:	MS. SUZANNE RUSSELL THORNBERRY
Credential	:	LCSW
Telephone Number	:	505-379-3703

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	05/19/2021

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Directions to “TRUE SELF LLC ” Practice Location

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