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General NPI Number Information
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NPI Number | 1760349500
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Entity Type | Individual
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Provider Name | AUTUMN M IVERSON
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 322 E GATEWAY DR STE 103-3
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City | HEBER CITY
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State | UT
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Zip | 84032-4610
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Country | US
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Telephone | 385-412-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 503 S 300 E
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City | MIDWAY
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State | UT
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Zip | 84049-1305
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Country | US
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Telephone | 801-735-9967
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | UT
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