Provider Demographics
NPI:1104215714
Name:EYRE, AUTUMN (BCBA, MIT)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:EYRE
Suffix:
Gender:F
Credentials:BCBA, MIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 SE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4809
Mailing Address - Country:US
Mailing Address - Phone:206-227-0619
Mailing Address - Fax:
Practice Address - Street 1:8021 SE 60TH ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4809
Practice Address - Country:US
Practice Address - Phone:206-227-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-14-17808103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst