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General NPI Number Information
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NPI Number | 1891105292
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Entity Type | Organization
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Legal Business Name | AUTHENTIC COUNSELING AND COACHING CENTER, LLC
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 3309 WINTHROP AVE 100
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City | FORT WORTH
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State | TX
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Zip | 76116-5614
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Country | US
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Telephone | 214-886-4872
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Fax |
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Provider Business Mailing Address
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Address Line | 8628 PAPER BIRCH LN
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City | FORT WORTH
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State | TX
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Zip | 76123-5058
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Country | US
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Telephone | 214-886-4872
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | BARBARA BECKER JONATITIS
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Credential | LPC
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Telephone | 214-886-4872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12258
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License Number State | TX
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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 | 55023
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License Number State | TX
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