Provider Demographics
NPI:1871326330
Name:AUTHENTIC LIFE MENTAL HEALTH COUNSELING, PLLC
Entity type:Organization
Organization Name:AUTHENTIC LIFE MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LADC, LMHC
Authorized Official - Phone:201-903-2461
Mailing Address - Street 1:2604 ELMWOOD AVE PMB 133
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:201-903-2461
Mailing Address - Fax:
Practice Address - Street 1:1051 DANBY RD APT 2
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5721
Practice Address - Country:US
Practice Address - Phone:201-903-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health