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General NPI Number Information
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NPI Number | 1366213787
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Entity Type | Individual
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Provider Name | KENDRA R RILEY LPCC, RN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 650 GOLD FLAT RD STE A
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City | NEVADA CITY
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State | CA
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Zip | 95959-3269
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Country | US
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Telephone | 530-648-0435
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Fax |
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Provider Business Mailing Address
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Address Line | 15046 MEADOW DR
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City | GRASS VALLEY
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State | CA
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Zip | 95945-9034
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Country | US
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Telephone | 530-263-2075
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC15865
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License Number State | CA
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