Provider Demographics
NPI:1578335923
Name:MORLAND, AUTUMN LEE
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LEE
Last Name:MORLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUTUMN L
Other - Middle Name:LEE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1457 DANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-461-7173
Mailing Address - Fax:
Practice Address - Street 1:1457 DANA AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-461-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health