Provider Demographics
NPI:1952767766
Name:LLOYD, AUTUMN (MA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:HUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 E QUEENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2985
Mailing Address - Country:US
Mailing Address - Phone:309-263-5565
Mailing Address - Fax:309-263-9336
Practice Address - Street 1:75 E QUEENWOOD RD
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2985
Practice Address - Country:US
Practice Address - Phone:309-263-5565
Practice Address - Fax:309-263-9336
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011554101Y00000X
IL180.010282101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178011554OtherLICENSE