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General NPI Number Information
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NPI Number | 1205436292
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY RENEWAL COUNSELING AND WELLNESS CENTER
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 809 US HIGHWAY 8
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City | SAINT CROIX FALLS
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State | WI
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Zip | 54024-8335
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Country | US
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Telephone | 715-483-7300
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Fax | 715-483-7301
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Provider Business Mailing Address
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Address Line | 809 US HIGHWAY 8
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City | SAINT CROIX FALLS
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State | WI
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Zip | 54024-8335
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Country | US
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Telephone | 715-483-7300
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Fax | 715-483-7301
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Authorized Official
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Title or Position | CEO
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Name | TAMMY BREAULT
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Credential | MA, LPC
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Telephone | 715-483-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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