| Authentic Self Therapy, Llc | |
|
848 Mountview Rd Lapeer MI 48446-9053 | |
| (810) 356-9925 | |
| Not Available |
| Full Name | Authentic Self Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 848 Mountview Rd, Lapeer, Michigan |
| Authorized Official Name and Position | Erin Cavanaugh (OWNER) |
| Authorized Official Contact | 8103569925 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic Self Therapy, Llc 848 Mountview Rd Lapeer MI 48446-9053 Ph: () - | Authentic Self Therapy, Llc 848 Mountview Rd Lapeer MI 48446-9053 Ph: (810) 356-9925 |
| NPI Number | 1700462702 |
|---|---|
| Provider Enumeration Date | 03/20/2021 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 6507273091 |
|---|---|
| Medicare Enrollment ID | O20210330000759 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700462702 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Erin Cavanaugh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144622077 PECOS PAC ID: 7315354800 Enrollment ID: I20210330001193 |
| Provider Name | Jackson Daly |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326537663 PECOS PAC ID: 1456700012 Enrollment ID: I20231208001040 |
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