1407432545 NPI number — AUTUMN LARSON HOOVER ACMHC, LVRC, CRC

Table of content: AUTUMN LARSON HOOVER ACMHC, LVRC, CRC (NPI 1407432545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407432545 NPI number — AUTUMN LARSON HOOVER ACMHC, LVRC, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOVER
Provider First Name:
AUTUMN
Provider Middle Name:
LARSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACMHC, LVRC, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOOVER
Provider Other First Name:
AUTUMN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407432545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1269 E 1900 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LOGAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84341-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-720-6632
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 OLD MAIN HILL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84322-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-797-4200
Provider Business Practice Location Address Fax Number:
844-308-5865
Provider Enumeration Date:
03/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  314561-6009 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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