Provider Demographics
NPI:1295618635
Name:AUTHENTICITY RECOVERY LLC
Entity type:Organization
Organization Name:AUTHENTICITY RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTYNE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ORTQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-638-7408
Mailing Address - Street 1:4500 CASCADE RD SE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3665
Mailing Address - Country:US
Mailing Address - Phone:616-638-7408
Mailing Address - Fax:
Practice Address - Street 1:4500 CASCADE RD SE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3665
Practice Address - Country:US
Practice Address - Phone:616-638-7408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)