Provider Demographics
NPI:1467014886
Name:AUTOTTE, LEA K (MA AMFT)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:K
Last Name:AUTOTTE
Suffix:
Gender:F
Credentials:MA AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 PORTER LN
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4747
Mailing Address - Country:US
Mailing Address - Phone:805-368-9199
Mailing Address - Fax:
Practice Address - Street 1:360 MOBIL AVE STE 207
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6372
Practice Address - Country:US
Practice Address - Phone:805-504-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT139241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist