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General NPI Number Information
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NPI Number | 1952675787
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Entity Type | Organization
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Legal Business Name | AUTHENTIC FREEDOM COUNSELING CENTER
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 4211 GRAND AVE # 12
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City | DES MOINES
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State | IA
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Zip | 50312-2423
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Country | US
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Telephone | 515-277-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 3775 EP TRUE PKWY # 119
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City | W DES MOINES
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State | IA
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Zip | 50265-7696
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Country | US
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Telephone | 515-277-0814
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK JOSEPH HILLENBRAND
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Credential | LISW
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Telephone | 515-277-0814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 06724
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License Number State | IA
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