Healthcare Provider Details

I. General information

NPI: 1447173000
Provider Name (Legal Business Name): RILEY BIDWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S DURANGO DR STE 100
LAS VEGAS NV
89145-2486
US

IV. Provider business mailing address

261 HULL ST
HENDERSON NV
89015-5607
US

V. Phone/Fax

Practice location:
  • Phone: 725-283-5106
  • Fax:
Mailing address:
  • Phone: 725-293-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4361
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: