Provider Demographics
NPI:1831630342
Name:AUTHENTIC LIVING PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:AUTHENTIC LIVING PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-767-8411
Mailing Address - Street 1:15 E KIRBY ST
Mailing Address - Street 2:STE 107 C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-4047
Mailing Address - Country:US
Mailing Address - Phone:248-767-8411
Mailing Address - Fax:
Practice Address - Street 1:15 E KIRBY ST
Practice Address - Street 2:STE 107 C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-4047
Practice Address - Country:US
Practice Address - Phone:248-767-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty