MEDICARE: AUTHENTIC MENTAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	104100000X	Social Worker

General Provider Information

NPI Number	:	1962128322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTIC MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2722 EDDY LN
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-1204
Country	:	US
Telephone Number	:	715-770-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 EDDY LN
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-1204
Country	:	US
Telephone Number	:	715-770-9180
Fax Number	:

Authorized Official
Title or Position	:	LCSW/OWNER
Name	:	MELISSA MAE JENNEMAN
Credential	:	LCSW
Telephone Number	:	715-828-3721

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	08/20/2025

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