Provider Demographics
NPI:1508521378
Name:AUTHENTIC SELF THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:AUTHENTIC SELF THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOUCET
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-206-5919
Mailing Address - Street 1:4200 ROCHESTER RD APT 207
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2736
Mailing Address - Country:US
Mailing Address - Phone:248-206-5919
Mailing Address - Fax:
Practice Address - Street 1:4200 ROCHESTER RD APT 207
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2736
Practice Address - Country:US
Practice Address - Phone:248-206-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty