Provider Demographics
NPI:1619206687
Name:ROBLES, AUTUM HYDE (LMFT)
Entity Type:Individual
Prefix:
First Name:AUTUM
Middle Name:HYDE
Last Name:ROBLES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 N SAN ANTONIO RD
Mailing Address - Street 2:STE H
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1371
Mailing Address - Country:US
Mailing Address - Phone:858-245-4834
Mailing Address - Fax:
Practice Address - Street 1:885 N SAN ANTONIO RD
Practice Address - Street 2:STE H
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1371
Practice Address - Country:US
Practice Address - Phone:858-245-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA77673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist