Provider Demographics
NPI:1083492904
Name:AUTHENTICALLY YOU COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:AUTHENTICALLY YOU COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRASK-ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:314-452-8600
Mailing Address - Street 1:226 S MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2711
Mailing Address - Country:US
Mailing Address - Phone:314-452-8600
Mailing Address - Fax:
Practice Address - Street 1:226 S MORRISON AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2711
Practice Address - Country:US
Practice Address - Phone:314-452-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty