Provider Demographics
NPI:1861149346
Name:AUTUMN CONSULTING, LLC
Entity type:Organization
Organization Name:AUTUMN CONSULTING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-216-3866
Mailing Address - Street 1:333 PERRY ST STE 212
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2434
Mailing Address - Country:US
Mailing Address - Phone:719-216-3866
Mailing Address - Fax:
Practice Address - Street 1:333 PERRY ST STE 212
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2434
Practice Address - Country:US
Practice Address - Phone:719-216-3866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC.14145OtherCOLORADO LICENSE