Provider Demographics
NPI:1619176047
Name:SPEARS, AUTUMN NICOLE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:NICOLE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 F ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6325
Mailing Address - Country:US
Mailing Address - Phone:707-825-1173
Mailing Address - Fax:707-825-1163
Practice Address - Street 1:685 F ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6325
Practice Address - Country:US
Practice Address - Phone:707-825-1173
Practice Address - Fax:707-825-1163
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist