| Authentic Counseling And Coaching Center, Llc | |
|
3309 Winthrop Ave 100 Fort Worth TX 76116-5614 | |
| (214) 886-4872 | |
| Not Available |
| Full Name | Authentic Counseling And Coaching Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3309 Winthrop Ave, Fort Worth, Texas |
| Authorized Official Name and Position | Barbara Becker Jonatitis (DIRECTOR OF CLINICAL SERVICES) |
| Authorized Official Contact | 2148864872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic Counseling And Coaching Center, Llc 8628 Paper Birch Ln Fort Worth TX 76123-5058 Ph: (214) 886-4872 | Authentic Counseling And Coaching Center, Llc 3309 Winthrop Ave 100 Fort Worth TX 76116-5614 Ph: (214) 886-4872 |
| NPI Number | 1891105292 |
|---|---|
| Provider Enumeration Date | 05/07/2014 |
| Last Update Date | 04/21/2020 |
| Certification Date | 04/21/2020 |
| Medicare PECOS PAC ID | 4688891997 |
|---|---|
| Medicare Enrollment ID | O20140811001178 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891105292 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 12258 (Texas) | Secondary |
| 1041C0700X | Social Worker - Clinical | 55023 (Texas) | Primary |
| Provider Name | Edna K Chism Nicholas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073933669 PECOS PAC ID: 4082831391 Enrollment ID: I20140811001691 |
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