MEDICARE: RIVER OF LIFE COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1063078228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER OF LIFE COUNSELING

Provider Business Mailing Address
First Line	:	1802 CHAPEL HILLS DR STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 CHAPEL HILLS DR STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3736
Country	:	US
Telephone Number	:	719-641-0009
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER BROWN
Credential	:	LPC
Telephone Number	:	719-641-0009

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	03/10/2026

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