Provider Demographics
NPI:1205686946
Name:TRUE NORTH LIFE QUEST, LLC
Entity type:Organization
Organization Name:TRUE NORTH LIFE QUEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FERN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-763-6023
Mailing Address - Street 1:532 VAL VISTA ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3655
Mailing Address - Country:US
Mailing Address - Phone:307-763-6023
Mailing Address - Fax:
Practice Address - Street 1:532 VAL VISTA ST STE 107
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3655
Practice Address - Country:US
Practice Address - Phone:307-763-6023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty