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General NPI Number Information
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NPI Number | 1093332207
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Entity Type | Organization
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Legal Business Name | RIVER WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 07/03/2020
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Last Update Date | 07/03/2020
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Provider Practice Location Address
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Address Line | 139 RIVER VISTA PL STE 106C
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City | TWIN FALLS
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State | ID
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Zip | 83301-3060
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Country | US
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Telephone | 208-731-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 2216 SETTLERS LN
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City | TWIN FALLS
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State | ID
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Zip | 83301-7889
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Country | US
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Telephone | 208-731-2896
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMBER GRAHAM
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Credential | LCSW
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Telephone | 208-731-2896
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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 |
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License Number State |
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