Provider Demographics
NPI:1851165575
Name:AUTHENTIC CONVERSATIONS THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:AUTHENTIC CONVERSATIONS THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA SHANDA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:TOLEFREE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, SAC
Authorized Official - Phone:414-533-5915
Mailing Address - Street 1:7445 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5373
Mailing Address - Country:US
Mailing Address - Phone:414-533-5915
Mailing Address - Fax:
Practice Address - Street 1:7445 20TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5373
Practice Address - Country:US
Practice Address - Phone:414-533-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty