MEDICARE: AUTUMN GOLLHOFER

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	1041C0700X	Clinical Social Worker	IC-2964	NV

General Provider Information

NPI Number	:	1851229843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN GOLLHOFER

Provider Business Mailing Address
First Line	:	120 FOX CROSSING AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5207
Country	:	US
Telephone Number	:	702-249-2214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 S RAINBOW BLVD # 210D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-249-2214
Fax Number	:

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “ AUTUMN GOLLHOFER ” Practice Location

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