=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740737204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVER VIEW COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 09/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 THIRD STREET
-----------------------------------------------------
City | GRANBY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-531-1996
-----------------------------------------------------
Fax | 970-557-3170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 N 3RD ST. POB 2274
-----------------------------------------------------
City | GRANBY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80446-2274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-531-1996
-----------------------------------------------------
Fax | 970-557-3170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MARY ENTRICAN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 970-531-1996
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 7511
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 383
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------