Provider Demographics
NPI:1407432545
Name:HOOVER, AUTUMN LARSON (ACMHC, LVRC, CRC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LARSON
Last Name:HOOVER
Suffix:
Gender:F
Credentials:ACMHC, LVRC, CRC
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:HOOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1269 E 1900 N
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2009
Mailing Address - Country:US
Mailing Address - Phone:435-720-6632
Mailing Address - Fax:
Practice Address - Street 1:6405 OLD MAIN HILL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-1723
Practice Address - Country:US
Practice Address - Phone:435-797-4200
Practice Address - Fax:844-308-5865
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314561-6009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor