MEDICARE: AUTHENTICALLY YOU WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1649087412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTICALLY YOU WELLNESS LLC

Provider Business Mailing Address
First Line	:	1114 N LEROY ST # 1016
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2758
Country	:	US
Telephone Number	:	810-337-8377
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 S ADELAIDE ST STE E
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2804
Country	:	US
Telephone Number	:	810-337-8377
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	ERICA MURTO
Credential	:	LPC
Telephone Number	:	810-730-0389

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/20/2025

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Directions to “AUTHENTICALLY YOU WELLNESS LLC ” Practice Location

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