Healthcare Provider Details

I. General information

NPI: 1225886633
Provider Name (Legal Business Name): TENLEY RISSOVER MT-BC, TRCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7374 READING RD STE 206
CINCINNATI OH
45237-3400
US

IV. Provider business mailing address

7374 READING RD STE 206
CINCINNATI OH
45237-3400
US

V. Phone/Fax

Practice location:
  • Phone: 513-987-2374
  • Fax:
Mailing address:
  • Phone: 513-910-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: