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General NPI Number Information
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NPI Number | 1215827985
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Entity Type | Organization
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Legal Business Name | AUTHENTIC LIFE COUNSELING PLLC
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Dates
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Enumeration Date | 07/05/2025
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Last Update Date | 07/05/2025
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Provider Practice Location Address
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Address Line | 3305 MAIN ST STE 9
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City | VANCOUVER
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State | WA
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Zip | 98663-2272
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Country | US
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Telephone | 360-207-1626
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 NE 67TH ST
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City | VANCOUVER
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State | WA
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Zip | 98665-0364
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Country | US
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Telephone | 360-207-1626
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ALLISON TOWNSEND
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Credential |
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Telephone | 360-713-1832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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