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General NPI Number Information
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NPI Number | 1457673139
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Entity Type | Individual
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Provider Name | JEROME C. RIVERS LPCC-S, LIMFT
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Gender | Male
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 4582 LEE RD
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City | CLEVELAND
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State | OH
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Zip | 44128-3759
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Country | US
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Telephone | 216-475-2112
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Fax | 216-475-2120
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Provider Business Mailing Address
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Address Line | PO BOX 281081
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City | CLEVELAND
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State | OH
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Zip | 44128-8181
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Country | US
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Telephone | 216-475-2112
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Fax | 216-475-2120
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0004292
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F0000120
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License Number State | OH
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