Provider Demographics
NPI:1710556824
Name:AUTHENTIC PATH THERAPY AND CONSULTATION
Entity Type:Organization
Organization Name:AUTHENTIC PATH THERAPY AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-587-4663
Mailing Address - Street 1:760 S KINGSHIGHWAY STE A1
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7630
Mailing Address - Country:US
Mailing Address - Phone:573-587-4663
Mailing Address - Fax:
Practice Address - Street 1:760 S KINGSHIGHWAY STE A1
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7630
Practice Address - Country:US
Practice Address - Phone:573-587-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty