Provider Demographics
NPI:1508007261
Name:TRUE SELF LLC
Entity Type:Organization
Organization Name:TRUE SELF LLC
Other - Org Name:TRUE SELF COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / OWNER / CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:THORNBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-379-3703
Mailing Address - Street 1:2900 LOUISIANA BLVD. NE
Mailing Address - Street 2:SUITE J-1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3532
Mailing Address - Country:US
Mailing Address - Phone:505-639-5772
Mailing Address - Fax:505-639-5772
Practice Address - Street 1:2900 LOUISIANA BLVD. NE
Practice Address - Street 2:SUITE J-1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3532
Practice Address - Country:US
Practice Address - Phone:505-639-5772
Practice Address - Fax:505-639-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI066181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45104336Medicaid