Basic Information
| Provider Information | |||||||||
| NPI: | 1558608042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | AUTUMN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 S BURDICK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693813700 | ||||||||
| FaxNumber: | 2693813810 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 S BURDICK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693813700 | ||||||||
| FaxNumber: | 2693813810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2013 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401012440 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.