NPIMap

Organization Active NPI

Authentic Counseling and Coaching Center, LLC

  • Clinical Social Worker
  • Fort Worth, TX
National Provider Identifier
1891105292
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
55023 Issued in TX
Legal business name
AUTHENTIC COUNSELING AND COACHING CENTER, LLC
Practice address
3309 Winthrop Ave
100
Fort Worth, TX 76116-5614
Phone
(214) 886-4872
NPI assigned
May 7, 2014
Last updated
Apr 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Barbara Becker Jonatitis, LPC
Title
Director of Clinical Services
Phone
(214) 886-4872

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 12258 TX
Clinical Social Worker 1041C0700X 55023 TX Primary

Addresses

Primary practice location

3309 Winthrop Ave
100
Fort Worth, TX 76116-5614

Mailing address

8628 Paper Birch LN
Fort Worth, TX 76123-5058
Phone (214) 886-4872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140811001178 TX Part B Supplier - Clinic/Group Practice 4688891997 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

3309 Winthrop Ave
Ste 100
Fort Worth, TX 76116
Phone (214) 886-4872

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1891105292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8628 PAPER BIRCH LN",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761235058",
            "telephone_number": "214-886-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3309 WINTHROP AVE",
            "address_2": "100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761165614",
            "telephone_number": "214-886-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC COUNSELING AND COACHING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-07",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "BECKER JONATITIS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "214-886-4872",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "12258",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "55023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.