Healthcare Provider Details

I. General information

NPI: 1710449814
Provider Name (Legal Business Name): AUTUMN ELISABETH ROSE ARENDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR STE 10
LAS VEGAS NV
89120-4429
US

IV. Provider business mailing address

3440 LAS VEGAS BLVD N
LAS VEGAS NV
89115-0599
US

V. Phone/Fax

Practice location:
  • Phone: 253-345-8750
  • Fax:
Mailing address:
  • Phone: 253-345-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: