Healthcare Provider Details

I. General information

NPI: 1407601875
Provider Name (Legal Business Name): RIVERS MARRIAGE AND FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 S LOS ROBLES AVE
PASADENA CA
91101-2872
US

IV. Provider business mailing address

272 S LOS ROBLES AVE
PASADENA CA
91101-2872
US

V. Phone/Fax

Practice location:
  • Phone: 626-460-0129
  • Fax:
Mailing address:
  • Phone: 626-460-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN HERMAN RIVERS
Title or Position: PRESIDENT
Credential: LMFT
Phone: 626-460-0129