Provider Demographics
NPI:1891105292
Name:AUTHENTIC COUNSELING AND COACHING CENTER, LLC
Entity Type:Organization
Organization Name:AUTHENTIC COUNSELING AND COACHING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER JONATITIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-886-4872
Mailing Address - Street 1:8628 PAPER BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5058
Mailing Address - Country:US
Mailing Address - Phone:214-886-4872
Mailing Address - Fax:
Practice Address - Street 1:3309 WINTHROP AVE
Practice Address - Street 2:100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5614
Practice Address - Country:US
Practice Address - Phone:214-886-4872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12258101YA0400X
TX550231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty