Provider Demographics
NPI:1174007124
Name:TRUE SELF COUNSELING & CONSULTATION, LLC
Entity Type:Organization
Organization Name:TRUE SELF COUNSELING & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-695-3871
Mailing Address - Street 1:710 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1565
Mailing Address - Country:US
Mailing Address - Phone:203-695-3871
Mailing Address - Fax:
Practice Address - Street 1:710 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1565
Practice Address - Country:US
Practice Address - Phone:203-695-3871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-16
Last Update Date:2018-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1407196280Medicaid
CT1407196280OtherATENA
CT1407196280OtherBLUE CROSS BLUE SHEILD
CT1407196280OtherOPTUM
CT1407196280OtherCIGNA