Provider Demographics
NPI:1073205175
Name:AUTHENTIC SELF BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:AUTHENTIC SELF BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOGLUND-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-491-0815
Mailing Address - Street 1:950 OFFICE PARK RD STE 127
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2586
Mailing Address - Country:US
Mailing Address - Phone:515-491-0815
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD STE 127
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2586
Practice Address - Country:US
Practice Address - Phone:515-491-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty