Provider Demographics
NPI:1093580482
Name:AUTHENTIC LIVING THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:AUTHENTIC LIVING THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GUT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-567-3468
Mailing Address - Street 1:201 W HIAWATHA TRAIL
Mailing Address - Street 2:
Mailing Address - City:MT. PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3763
Mailing Address - Country:US
Mailing Address - Phone:224-567-3468
Mailing Address - Fax:
Practice Address - Street 1:201 W HIAWATHA TRAIL
Practice Address - Street 2:
Practice Address - City:MT. PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3763
Practice Address - Country:US
Practice Address - Phone:224-567-3468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty