Provider Demographics
NPI:1851836837
Name:MCKAMIE, AUTUMN FANNIN (MA)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:FANNIN
Last Name:MCKAMIE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:FANNIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4255 CAMPUS DR STE A245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8630
Mailing Address - Country:US
Mailing Address - Phone:888-699-4873
Mailing Address - Fax:
Practice Address - Street 1:4255 CAMPUS DR STE A245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8630
Practice Address - Country:US
Practice Address - Phone:888-699-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85468106H00000X
CA124088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist