Provider Demographics
NPI:1003905118
Name:RIOS, AUTUMN (LMFT)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:VALERIE
Other - Last Name:STEPHENSON-RIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:NM
Mailing Address - Zip Code:87567-1462
Mailing Address - Country:US
Mailing Address - Phone:505-747-0022
Mailing Address - Fax:505-747-0022
Practice Address - Street 1:600 E FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2816
Practice Address - Country:US
Practice Address - Phone:505-920-3596
Practice Address - Fax:505-455-9290
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0086081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist