MEDICARE: AUTHENTIC COUNSELING AND THERAPY, PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1871347930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTIC COUNSELING AND THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1045 FERRARI DR
Second Line	:
City	:	COAL CITY
State	:	IL
Zip	:	60416-1843
Country	:	US
Telephone Number	:	815-735-9108
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 FERRARI DR
Second Line	:
City	:	COAL CITY
State	:	IL
Zip	:	60416-1843
Country	:	US
Telephone Number	:	815-735-9108
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MRS. CHRISTINA CHRISTENSEN
Credential	:	LCPC
Telephone Number	:	815-735-9108

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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