| Authentic Life Center LLC | |
|
210 E Main St Ste 16 Niles MI 49120-2376 | |
| (269) 409-1276 | |
| Not Available |
| Full Name | Authentic Life Center LLC |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 210 E Main St Ste 16, Niles, Michigan |
| Authorized Official Name and Position | Tiffany Russell (OWNER) |
| Authorized Official Contact | 5743236996 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic Life Center LLC 78 Sunset Ln Niles MI 49120-9344 Ph: (574) 323-6996 | Authentic Life Center LLC 210 E Main St Ste 16 Niles MI 49120-2376 Ph: (269) 409-1276 |
| NPI Number | 1871102673 |
|---|---|
| Provider Enumeration Date | 07/28/2020 |
| Last Update Date | 07/28/2020 |
| Certification Date | 07/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871102673 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
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