Provider Demographics
NPI:1902625353
Name:TRUE, JONATHAN TIMOTHY
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TIMOTHY
Last Name:TRUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 BRENTWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8890
Mailing Address - Country:US
Mailing Address - Phone:508-736-7195
Mailing Address - Fax:
Practice Address - Street 1:2812 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1308
Practice Address - Country:US
Practice Address - Phone:612-345-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician