Healthcare Provider Details

I. General information

NPI: 1457607186
Provider Name (Legal Business Name): AUTUMN CHANDRA PIONTEK-WALSH M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 E FRONT ST
PORT ANGELES WA
98362-3319
US

IV. Provider business mailing address

423 S ALBERT ST
PORT ANGELES WA
98362-3417
US

V. Phone/Fax

Practice location:
  • Phone: 360-775-1071
  • Fax:
Mailing address:
  • Phone: 360-775-1071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60622185
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60293067
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: