Provider Demographics
NPI:1598834277
Name:HART, AUTUMNE RENE' (LPC)
Entity Type:Individual
Prefix:
First Name:AUTUMNE
Middle Name:RENE'
Last Name:HART
Suffix:
Gender:F
Credentials:LPC
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 2060
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-2060
Mailing Address - Country:US
Mailing Address - Phone:903-577-1224
Mailing Address - Fax:
Practice Address - Street 1:404 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3841
Practice Address - Country:US
Practice Address - Phone:903-577-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7319LCOtherBLUE CROSS BLUE SHIELD