Provider Demographics
NPI:1437815255
Name:AUTHENTIC LIFE LLC
Entity Type:Organization
Organization Name:AUTHENTIC LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LSCSW
Authorized Official - Phone:816-381-7690
Mailing Address - Street 1:224 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2816
Mailing Address - Country:US
Mailing Address - Phone:816-381-7690
Mailing Address - Fax:816-381-7652
Practice Address - Street 1:224 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2816
Practice Address - Country:US
Practice Address - Phone:816-381-7690
Practice Address - Fax:816-381-7652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty