Provider Demographics
NPI:1588963300
Name:MCCONNELL, AUTUMN CADE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:CADE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:CADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:232 E GISH RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4706
Mailing Address - Country:US
Mailing Address - Phone:818-445-2805
Mailing Address - Fax:
Practice Address - Street 1:914 CATKIN CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4718
Practice Address - Country:US
Practice Address - Phone:818-445-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81034106H00000X
CALMFT81034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist