Provider Demographics
NPI:1689346207
Name:MARZETTE-ANDERSON, AUTUMN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:
Last Name:MARZETTE-ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:MARZETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2901 35TH ST LOWR SUITEB
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-5117
Mailing Address - Country:US
Mailing Address - Phone:262-764-2459
Mailing Address - Fax:262-558-0429
Practice Address - Street 1:2901 35TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5117
Practice Address - Country:US
Practice Address - Phone:262-764-2459
Practice Address - Fax:262-558-0429
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional