Provider Demographics
NPI:1235919192
Name:AUTHENTIC LIVING COUNSELING
Entity Type:Organization
Organization Name:AUTHENTIC LIVING COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:360-899-8577
Mailing Address - Street 1:7939 SW 163RD ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-8690
Mailing Address - Country:US
Mailing Address - Phone:360-899-8577
Mailing Address - Fax:
Practice Address - Street 1:7939 SW 163RD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-8690
Practice Address - Country:US
Practice Address - Phone:360-899-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center