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General NPI Number Information
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NPI Number | 1023718871
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Entity Type | Individual
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Provider Name | VIVIENNE K RISELEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 115 W KAGY BLVD STE O
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City | BOZEMAN
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State | MT
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Zip | 59715-6026
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Country | US
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Telephone | 406-282-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 280 W KAGY BLVD STE D PMB 222
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City | BOZEMAN
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State | MT
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Zip | 59715-6026
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Country | US
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Telephone | 406-282-3055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-64896
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License Number State | MT
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