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General NPI Number Information
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NPI Number | 1821751538
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Entity Type | Organization
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Legal Business Name | VALLEY RIVER COUNSELING LLC
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 1717 CENTENNIAL BLVD STE 12
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3378
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Country | US
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Telephone | 541-236-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 CENTENNIAL BLVD STE 12
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3378
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Country | US
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Telephone | 541-236-3057
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | SCOTT J WATERS
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Credential | LPC
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Telephone | 541-236-3057
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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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