MEDICARE: AUTUMN MAXWELL

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	101552	TX

General Provider Information

NPI Number	:	1629929393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN MAXWELL

Provider Business Mailing Address
First Line	:	3412 SLOANE ST APT 311
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2353
Country	:	US
Telephone Number	:	614-512-2650
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 SLOANE ST APT 311
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2353
Country	:	US
Telephone Number	:	614-512-2650
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ AUTUMN MAXWELL ” Practice Location

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