Authentic Self Therapy Pllc | |
407 Cedarwood Ct Waite Park MN 56387-4504 | |
(701) 552-2992 | |
Not Available |
Full Name | Authentic Self Therapy Pllc |
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Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 407 Cedarwood Ct, Waite Park, Minnesota |
Authorized Official Name and Position | Nicolette R Johnson (THERAPIST) |
Authorized Official Contact | 7015522992 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Authentic Self Therapy Pllc 407 Cedarwood Ct Waite Park MN 56387-4504 Ph: (701) 552-2992 | Authentic Self Therapy Pllc 407 Cedarwood Ct Waite Park MN 56387-4504 Ph: (701) 552-2992 |
NPI Number | 1255013504 |
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Provider Enumeration Date | 08/07/2023 |
Last Update Date | 08/07/2023 |
Certification Date | 08/05/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255013504 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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