MEDICARE: AUTHENTIC LIFE COUNSELING CHICAGO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770231789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTIC LIFE COUNSELING CHICAGO PLLC

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE STE 529
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3491
Country	:	US
Telephone Number	:	312-448-7938
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE STE 529
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3491
Country	:	US
Telephone Number	:	312-448-7938
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY DAWN REPINSKI
Credential	:	LCPC, CADC
Telephone Number	:	312-448-7938

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	01/21/2026

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