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General NPI Number Information
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NPI Number | 1851165575
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Entity Type | Organization
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Legal Business Name | AUTHENTIC CONVERSATIONS THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | 7445 20TH AVE
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City | KENOSHA
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State | WI
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Zip | 53143-5373
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Country | US
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Telephone | 414-533-5915
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1013
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City | KENOSHA
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State | WI
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Zip | 53141-1013
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Country | US
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Telephone | 262-371-5600
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. LA SHANDA MARIA TOLEFREE
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Credential | MA, LPC, SAC
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Telephone | 262-371-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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