Healthcare Provider Details

I. General information

NPI: 1841120623
Provider Name (Legal Business Name): AUTUMN MATTOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 HEAVENLY DAYS ST
INMAN SC
29349-8339
US

IV. Provider business mailing address

227 WHEELER RD
SPARTANBURG SC
29302-5729
US

V. Phone/Fax

Practice location:
  • Phone: 864-310-8569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-534261
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: