| Authentic You | |
|
819 30th Ave S Ste 103d Moorhead MN 56560-5000 | |
| (701) 428-2327 | |
| Not Available |
| Full Name | Authentic You |
|---|---|
| Speciality | Counselor |
| Location | 819 30th Ave S Ste 103d, Moorhead, Minnesota |
| Authorized Official Name and Position | Alyssa Wennerberg (MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 7014282327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic You 819 30th Ave S Ste 103d Moorhead MN 56560-5000 Ph: () - | Authentic You 819 30th Ave S Ste 103d Moorhead MN 56560-5000 Ph: (701) 428-2327 |
| NPI Number | 1851110928 |
|---|---|
| Provider Enumeration Date | 10/07/2024 |
| Last Update Date | 12/19/2024 |
| Certification Date | 12/19/2024 |
| Medicare PECOS PAC ID | 9234667122 |
|---|---|
| Medicare Enrollment ID | O20250106001674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851110928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Alyssa Wennerberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811414857 PECOS PAC ID: 6406207570 Enrollment ID: I20240112003040 |
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