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General NPI Number Information
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NPI Number | 1144425018
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Entity Type | Organization
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Legal Business Name | SIX RIVERS COUNSELING
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 182 SW 10TH ST
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City | ONTARIO
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State | OR
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Zip | 97914-2134
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Country | US
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Telephone | 208-452-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 182 SW 10TH ST
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City | ONTARIO
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State | OR
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Zip | 97914-2134
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Country | US
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Telephone | 208-452-7190
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | MR. BRAD W LEVITT
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Credential | PSYD
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Telephone | 208-452-7190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-202138
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-119
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License Number State | OR
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