Provider Demographics
NPI:1407432545
Name:HOOVER, AUTUMN LARSON (CMHC, MRC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LARSON
Last Name:HOOVER
Suffix:
Gender:F
Credentials:CMHC, MRC
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:HOOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMHC
Mailing Address - Street 1:1269 E 1900 N
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2009
Mailing Address - Country:US
Mailing Address - Phone:435-720-6632
Mailing Address - Fax:
Practice Address - Street 1:1269 E 1900 N
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2009
Practice Address - Country:US
Practice Address - Phone:435-720-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT314561-6009101Y00000X
UT314561-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health