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General NPI Number Information
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NPI Number | 1508519547
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Entity Type | Individual
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Provider Name | AUTUMN JAMES MA, LLP
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Gender | Female
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 21056 DEAN ST
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City | WARREN
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State | MI
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Zip | 48091-2760
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Country | US
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Telephone | 586-806-4678
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Fax |
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Provider Business Mailing Address
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Address Line | 19936 COUNTRY CLUB DR
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City | HARPER WOODS
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State | MI
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Zip | 48225-1622
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Country | US
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Telephone | 313-695-6763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361007468
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License Number State | MI
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