Healthcare Provider Details

I. General information

NPI: 1316742570
Provider Name (Legal Business Name): RIVERSTONE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MANHATTAN DR STE 206
BOULDER CO
80303-4252
US

IV. Provider business mailing address

75 MANHATTAN DR STE 206
BOULDER CO
80303-4252
US

V. Phone/Fax

Practice location:
  • Phone: 720-802-6925
  • Fax:
Mailing address:
  • Phone: 720-808-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH HOLUB
Title or Position: EXECUTIVE DIRECTOR
Credential: MHA, LAC, CAS
Phone: 720-808-2150