Provider Demographics
NPI:1952675787
Name:AUTHENTIC FREEDOM COUNSELING CENTER
Entity Type:Organization
Organization Name:AUTHENTIC FREEDOM COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HILLENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-277-0814
Mailing Address - Street 1:3775 EP TRUE PKWY # 119
Mailing Address - Street 2:
Mailing Address - City:W DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7696
Mailing Address - Country:US
Mailing Address - Phone:515-277-0814
Mailing Address - Fax:
Practice Address - Street 1:4211 GRAND AVE # 12
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2423
Practice Address - Country:US
Practice Address - Phone:515-277-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06724251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health