Provider Demographics
NPI:1497445779
Name:PIERCE, AUTUMN (PCLC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 SUNNYBROOK DR APT 304
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6471
Mailing Address - Country:US
Mailing Address - Phone:208-304-7587
Mailing Address - Fax:
Practice Address - Street 1:700 N EWING ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3605
Practice Address - Country:US
Practice Address - Phone:208-304-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-64717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health