MEDICARE: RIVERTOWN WELLNESS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1215535513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERTOWN WELLNESS

Provider Business Mailing Address
First Line	:	3380 ERIE AVE STE 202
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 ERIE AVE STE 202
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:	513-759-9744
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CODY HANSON
Credential	:	MS, LPC
Telephone Number	:	513-399-6511

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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Directions to “RIVERTOWN WELLNESS ” Practice Location

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