Healthcare Provider Details

I. General information

NPI: 1376384453
Provider Name (Legal Business Name): AUTUMN YOPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 E SPEEDWAY BLVD
TUCSON AZ
85712-5301
US

IV. Provider business mailing address

4585 E SPEEDWAY BLVD
TUCSON AZ
85712-5301
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-4505
  • Fax:
Mailing address:
  • Phone: 520-327-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAAC-08059T
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: