Organization
AUTHENTIC SELF THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLETTE R JOHNSON LPCC; LADC/LMAC (THERAPIST)
(320) 855-6557
Entity
Organization
Contact information
Practice address
103 DOCTORS PARK, SAINT CLOUD, MN 56303-1207
(320) 855-6557
(320) 238-7456
Mailing address
103 DOCTORS PARK, SAINT CLOUD, MN 56303-1207
(320) 855-6557
(320) 238-7456
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
08/07/2023
Last updated
08/04/2025
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