Provider Demographics
NPI:1023566486
Name:TRUE NORTH PTSD CENTER
Entity Type:Organization
Organization Name:TRUE NORTH PTSD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:217-402-4071
Mailing Address - Street 1:201 W SPRINGFIELD AVE
Mailing Address - Street 2:1006
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6385
Mailing Address - Country:US
Mailing Address - Phone:217-402-4071
Mailing Address - Fax:217-531-4047
Practice Address - Street 1:201 W SPRINGFIELD AVE
Practice Address - Street 2:1006
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6385
Practice Address - Country:US
Practice Address - Phone:217-402-4071
Practice Address - Fax:217-531-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1467870337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty