Healthcare Provider Details

I. General information

NPI: 1265378921
Provider Name (Legal Business Name): RILEY MOYLE LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 LOVERS LN STE 102
PORTAGE MI
49002-1521
US

IV. Provider business mailing address

26780 COUNTY ROAD 364
MATTAWAN MI
49071-9557
US

V. Phone/Fax

Practice location:
  • Phone: 269-993-4800
  • Fax:
Mailing address:
  • Phone: 269-993-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: