Healthcare Provider Details

I. General information

NPI: 1619585296
Provider Name (Legal Business Name): AUTUMN MICHELLE BROCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD
CHICO CA
95926-2281
US

IV. Provider business mailing address

1632 LAUREL ST
CHICO CA
95928-6655
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2810
  • Fax:
Mailing address:
  • Phone: 530-852-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number128131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: