=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164294476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUTUMN SCHULZ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2023
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 173 GRAY RD
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-344-4299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6126
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-344-4299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | AUTUMN SCHULZ
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 207-344-4299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------