Healthcare Provider Details

I. General information

NPI: 1013156744
Provider Name (Legal Business Name): CRISTY SUE LEONARD-RIVERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 3RD ST STE 500
CARLTON MN
55718-3700
US

IV. Provider business mailing address

810 3RD ST
CARLTON MN
55718-3700
US

V. Phone/Fax

Practice location:
  • Phone: 218-384-7008
  • Fax: 651-431-7679
Mailing address:
  • Phone: 218-384-7008
  • Fax: 651-431-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1133
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC03858
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: