Provider Demographics
NPI:1073907622
Name:TRUEBLOOD PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:TRUEBLOOD PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRUEBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-222-2882
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-0093
Mailing Address - Country:US
Mailing Address - Phone:262-222-2882
Mailing Address - Fax:
Practice Address - Street 1:19275 W CAPITOL DR STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2734
Practice Address - Country:US
Practice Address - Phone:262-222-2882
Practice Address - Fax:414-431-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-22
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2975-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty