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General NPI Number Information
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NPI Number | 1003218132
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Entity Type | Organization
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Legal Business Name | RIVERBANK COUNSELING
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 519 S 4TH ST W
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City | MISSOULA
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State | MT
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Zip | 59801-2629
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Country | US
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Telephone | 406-207-7554
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Fax |
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Provider Business Mailing Address
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Address Line | 519 S 4TH ST W
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City | MISSOULA
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State | MT
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Zip | 59801-2629
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Country | US
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Telephone | 406-207-7554
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | JENNIFER BOEHMKE HUDSON
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Credential | LCPC
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Telephone | 406-207-7554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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