Provider Demographics
NPI:1376301176
Name:OR, LIKHET AUTUMN
Entity Type:Individual
Prefix:
First Name:LIKHET
Middle Name:AUTUMN
Last Name:OR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HUNTINGTON AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4615
Mailing Address - Country:US
Mailing Address - Phone:617-266-7040
Mailing Address - Fax:
Practice Address - Street 1:270 HUNTINGTON AVE APT 401
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-4615
Practice Address - Country:US
Practice Address - Phone:617-266-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI13543758101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor