Provider Demographics
NPI:1760283428
Name:BITTEL, AUTUMN JADE (SSP, NCSP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:JADE
Last Name:BITTEL
Suffix:
Gender:
Credentials:SSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 JEANETTE BENTON DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1748
Mailing Address - Country:US
Mailing Address - Phone:502-439-0950
Mailing Address - Fax:
Practice Address - Street 1:1301 JUDSON ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1454
Practice Address - Country:US
Practice Address - Phone:502-439-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN000009348103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool