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General NPI Number Information
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NPI Number | 1376157453
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Entity Type | Organization
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Legal Business Name | RIVER ROCK BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 50 CRESTWOOD EXECUTIVE CTR STE 308
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1900
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Country | US
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Telephone | 314-408-7676
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Fax | 314-328-5453
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Provider Business Mailing Address
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Address Line | 50 CRESTWOOD EXECUTIVE CTR STE 308
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1900
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Country | US
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Telephone | 314-408-7676
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Fax | 314-328-5453
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA L. HARVATH
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Credential | PH.D.
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Telephone | 314-408-7676
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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 |
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License Number State |
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