Healthcare Provider Details

I. General information

NPI: 1902560923
Provider Name (Legal Business Name): RIVERBEND THERAPEUTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 PARK DR S STE A
GREAT FALLS MT
59401-3612
US

IV. Provider business mailing address

PO BOX 2851
GREAT FALLS MT
59403-2851
US

V. Phone/Fax

Practice location:
  • Phone: 406-781-4973
  • Fax: 406-403-0222
Mailing address:
  • Phone: 406-781-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACY PETERSON
Title or Position: OWNER
Credential: LCPC
Phone: 406-781-4973