Provider Demographics
NPI:1497216071
Name:AUTHENTIC TALK
Entity Type:Organization
Organization Name:AUTHENTIC TALK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAUGHNS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-368-1288
Mailing Address - Street 1:14806 PINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-4573
Mailing Address - Country:US
Mailing Address - Phone:816-588-5090
Mailing Address - Fax:
Practice Address - Street 1:721 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2328
Practice Address - Country:US
Practice Address - Phone:816-368-1288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty