Provider Demographics
NPI:1275899056
Name:AUTHENTIC THERAPIES
Entity Type:Organization
Organization Name:AUTHENTIC THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-294-9237
Mailing Address - Street 1:1898 FISK RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8823
Mailing Address - Country:US
Mailing Address - Phone:517-294-9237
Mailing Address - Fax:
Practice Address - Street 1:144 SCHROEDER PARK DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8990
Practice Address - Country:US
Practice Address - Phone:517-294-9237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010878821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty