Provider Demographics
NPI:1417452079
Name:TRUE NORTH PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:TRUE NORTH PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:603-361-5174
Mailing Address - Street 1:1321 WASHINGTON AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3675
Mailing Address - Country:US
Mailing Address - Phone:603-361-5174
Mailing Address - Fax:207-221-9986
Practice Address - Street 1:1321 WASHINGTON AVE STE 304
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3675
Practice Address - Country:US
Practice Address - Phone:603-361-5174
Practice Address - Fax:207-221-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC144981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty