Healthcare Provider Details

I. General information

NPI: 1386506194
Provider Name (Legal Business Name): AUTHENTIC HEALING THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 OFFICE PARK RD STE 115B
WEST DES MOINES IA
50265-2509
US

IV. Provider business mailing address

1001 OFFICE PARK RD STE 115B
WEST DES MOINES IA
50265-2509
US

V. Phone/Fax

Practice location:
  • Phone: 515-518-0583
  • Fax:
Mailing address:
  • Phone: 515-518-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ACKERMAN
Title or Position: OWNER/PRACTITIONER
Credential: MA
Phone: 515-238-6312