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NPI Code Detail

MEDICARE: AUTUMN LEAF COUNSELING

MEDICARE: AUTUMN LEAF COUNSELING
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1922668847
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTUMN LEAF COUNSELING
Provider Business Mailing Address
First Line : 943 MAPLE AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-4973
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 943 MAPLE AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-4973
Country : US
Telephone Number : 630-346-6713
Fax Number :
Authorized Official
Title or Position : COUNSELOR
Name : JORIE MIKLOS
Credential :
Telephone Number : 630-346-6713
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/13/2019

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Directions to “AUTUMN LEAF COUNSELING ” Practice Location

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