Provider Demographics
NPI:1336675040
Name:ASCANO, AUTUMN (JD, MS)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:ASCANO
Suffix:
Gender:F
Credentials:JD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80960-0203
Mailing Address - Country:US
Mailing Address - Phone:719-219-8626
Mailing Address - Fax:
Practice Address - Street 1:1257 LAKE PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3561
Practice Address - Country:US
Practice Address - Phone:719-219-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional