Provider Demographics
NPI:1912216326
Name:WHALEY, AUTUMN MELODY (BS, MA)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:MELODY
Last Name:WHALEY
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:MRS
Other - First Name:AUTUMN
Other - Middle Name:MELODY WHALEY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1750 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5700
Mailing Address - Country:US
Mailing Address - Phone:541-474-5579
Mailing Address - Fax:541-474-5842
Practice Address - Street 1:1750 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5700
Practice Address - Country:US
Practice Address - Phone:541-474-5579
Practice Address - Fax:541-474-5842
Is Sole Proprietor?:No
Enumeration Date:2010-10-03
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional