| NPI | 1851836837 |
|---|---|
| Former Name | AUTUMN FANNIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124088) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 85468) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2021-03-09 |