Provider Demographics
NPI:1841740396
Name:GOOD-HINTON, AUTUMNE CHRISHAUNA (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:AUTUMNE
Middle Name:CHRISHAUNA
Last Name:GOOD-HINTON
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:AUTUMNE
Other - Middle Name:
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, NCC, LPC
Mailing Address - Street 1:6805 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1977
Mailing Address - Country:US
Mailing Address - Phone:719-695-0397
Mailing Address - Fax:719-631-0699
Practice Address - Street 1:6805 CORPORATE DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1977
Practice Address - Country:US
Practice Address - Phone:719-695-0397
Practice Address - Fax:719-631-0699
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-08
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49413601Medicaid