Provider Demographics
NPI:1558024943
Name:AUTHENTIGO HEALTH
Entity Type:Organization
Organization Name:AUTHENTIGO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP, LCSW
Authorized Official - Phone:480-980-6330
Mailing Address - Street 1:1166 E WARNER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3065
Mailing Address - Country:US
Mailing Address - Phone:480-980-6330
Mailing Address - Fax:
Practice Address - Street 1:1166 E WARNER RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3065
Practice Address - Country:US
Practice Address - Phone:480-980-6330
Practice Address - Fax:480-485-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty