MEDICARE: AUTUMN CHASE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6255	CT

General Provider Information

NPI Number	:	1326792912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN CHASE LPC

Provider Business Mailing Address
First Line	:	34 PARK CIR
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-4832
Country	:	US
Telephone Number	:	860-906-2147
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 PARK CIR
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-4832
Country	:	US
Telephone Number	:	860-906-2147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	06/03/2026

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Directions to “ AUTUMN CHASE LPC” Practice Location

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