Healthcare Provider Details

I. General information

NPI: 1649087412
Provider Name (Legal Business Name): AUTHENTICALLY YOU WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S ADELAIDE ST STE E
FENTON MI
48430-2804
US

IV. Provider business mailing address

1114 N LEROY ST # 1016
FENTON MI
48430-2758
US

V. Phone/Fax

Practice location:
  • Phone: 810-337-8377
  • Fax:
Mailing address:
  • Phone: 810-337-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERICA MURTO
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 810-730-0389