Provider Demographics
NPI:1689337214
Name:AUTUMN HOUSE COUNSELING PLLC
Entity Type:Organization
Organization Name:AUTUMN HOUSE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:773-679-0986
Mailing Address - Street 1:18300 S HALSTED ST
Mailing Address - Street 2:STE B #214
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1051
Mailing Address - Country:US
Mailing Address - Phone:773-679-0986
Mailing Address - Fax:
Practice Address - Street 1:18300 S HALSTED ST
Practice Address - Street 2:STE B #214
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1051
Practice Address - Country:US
Practice Address - Phone:773-679-0986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty