Authentic Living Therapeutic Services Inc

Key facts

NPI

1093580482

Entity type

Organization (NPI type 2)

Primary specialty

Professional Counselor 101YP2500X

Legal business name

AUTHENTIC LIVING THERAPEUTIC SERVICES INC

Practice address

201 W Hiawatha Trail
Mt. Prospect, IL 60056-3763

Phone

(224) 567-3468

NPI assigned

Nov 16, 2023

Organization subpart

No

Authorized official

Name

Joyce Ann Gut, LCPC NPI 1366062655

Title

LCPC, Owner

Phone

(224) 567-3468

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joyce A Gut Mental Health Counselor · Mt Prospect, IL · NPI 1366062655
  Medicare reassignment NPD Authorized official IL

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 30, 2024.

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1093580482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W HIAWATHA TRAIL",
            "city": "MT. PROSPECT",
            "state": "IL",
            "postal_code": "600563763",
            "telephone_number": "224-567-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W HIAWATHA TRAIL",
            "city": "MT. PROSPECT",
            "state": "IL",
            "postal_code": "600563763",
            "telephone_number": "224-567-3468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1750 E Golf Rd Ste 1112",
            "address_purpose": "LOCATION",
            "city": "Schaumburg",
            "state": "IL",
            "postal_code": "601735835",
            "country_code": "US",
            "telephone_number": "224-567-3468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AUTHENTIC LIVING THERAPEUTIC SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-16",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "GUT",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "LCPC, OWNER",
        "authorized_official_telephone_number": "224-567-3468",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Mt. Prospect, IL · Professional Counselor in Illinois