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General NPI Number Information
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NPI Number | 1609042498
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Entity Type | Individual
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Provider Name | AUTUMN M VENDRAMIN LMHC, BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 442 N CALUMET RD STE 100
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City | CHESTERTON
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State | IN
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Zip | 46304-2489
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Country | US
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Telephone | 219-359-3272
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Fax | 219-359-3089
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Provider Business Mailing Address
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Address Line | 4989 W 450 N
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City | LA PORTE
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State | IN
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Zip | 46350-7403
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Country | US
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Telephone | 219-508-1594
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Fax | 219-359-3089
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39001748A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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