| Doctor Name: | MISS AUTUMN BROOKE WALTON |
| NPI Number: | 1184927865 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., LPC, CSAYC |
| License Number: | 6401013610 |
| Business Practice Address: | 30 N. Main St. Three Rivers, MI - 49093 |
| Business Phone Number: | 2698589959 |
| Business Fax Number: | |
| Mailing Address: | 30 N. Main St., THREE RIVERS |
| State: | MI |
| Postal Code: | 49093 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2010 |
| NPI Last Update Date: | 05/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401013610 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |