Provider Demographics
NPI:1003165846
Name:AUTHENTIC COUNSELING ASSOCIATES - A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:AUTHENTIC COUNSELING ASSOCIATES - A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MATHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-709-1170
Mailing Address - Street 1:11344 COLOMA RD
Mailing Address - Street 2:SUITE 435
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4457
Mailing Address - Country:US
Mailing Address - Phone:916-709-1170
Mailing Address - Fax:
Practice Address - Street 1:11344 COLOMA RD
Practice Address - Street 2:SUITE 435
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4457
Practice Address - Country:US
Practice Address - Phone:916-709-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty