Authentic Life Counseling and Wellness, PLLC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801093573 Issued in MI

Legal business name

AUTHENTIC LIFE COUNSELING AND WELLNESS, PLLC

Practice address

1200 W Eleventh St
Suite 218
Traverse City, MI 49684-3287

Phone

(231) 714-0292

NPI assigned

Jan 21, 2017

Last updated

Jan 21, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristina Wiersema, LMSWNPI 1346517513

Title

Owner

Phone

(231) 714-0292

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristina Kaye Wiersema, LMSW

  • Clinical Social Worker
  • Traverse City, MI
  • NPI 1346517513
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484956800000",
    "number": "1518404128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13554 S HIGH POINT DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845534",
            "telephone_number": "231-714-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W ELEVENTH ST",
            "address_2": "SUITE 218",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843287",
            "telephone_number": "231-714-0292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC LIFE COUNSELING AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-21",
        "last_updated": "2017-01-21",
        "status": "A",
        "authorized_official_last_name": "WIERSEMA",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-714-0292",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801093573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marc Austhof, OD
• Erica Ann Austin, DO
• Kyrsten Austin, MS, RD
• Paula Jean Austin, MA, CCC-SLP
• William A Austin, M.D.
• Autism Center of Northern Michigan
• Constance Averill, PH.D, LMSW, ACSW
• Ann M Avery, NURSE PRACTITIONER
• Ashley Avery
• Bianca Avolio

• Social Worker in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.