Provider Demographics
NPI:1194316778
Name:TRUE NORTH COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:TRUE NORTH COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAZE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:KOTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-643-2610
Mailing Address - Street 1:881 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9351
Mailing Address - Country:US
Mailing Address - Phone:484-354-4499
Mailing Address - Fax:
Practice Address - Street 1:3522 SILVERSIDE RD STE 32
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4915
Practice Address - Country:US
Practice Address - Phone:484-354-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14202873OtherCAQH