Provider Demographics
NPI:1841880192
Name:TRUBLU THERAPY, PLLC
Entity type:Organization
Organization Name:TRUBLU THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:UGOLINI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-310-1480
Mailing Address - Street 1:531 BRENTWOOD RD SUITE 153
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0269
Mailing Address - Country:US
Mailing Address - Phone:704-310-1480
Mailing Address - Fax:704-966-0135
Practice Address - Street 1:8040 ORTONVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4468
Practice Address - Country:US
Practice Address - Phone:980-319-8722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty