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General NPI Number Information
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NPI Number | 1124347489
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Entity Type | Organization
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Legal Business Name | RISSE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 101 E MAIN ST SUITE 2100
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City | FESTUS
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State | MO
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Zip | 63028-1977
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Country | US
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Telephone | 636-933-4870
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E MAIN ST SUITE 2100
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City | FESTUS
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State | MO
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Zip | 63028-1977
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Country | US
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Telephone | 636-933-4870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARTIN ALPHONSE RISSE JR.
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Credential | LPC
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Telephone | 636-933-4870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2005038598
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License Number State | MO
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