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General NPI Number Information
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NPI Number | 1902393036
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Entity Type | Organization
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Legal Business Name | RIVERSIDE THERAPY, LLC
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 1140 1ST AVE N STE 217
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City | BILLINGS
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State | MT
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Zip | 59101
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Country | US
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Telephone | 406-698-5299
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51434
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City | BILLINGS
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State | MT
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Zip | 59105-1361
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Country | US
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Telephone | 406-698-5299
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIE HAYES
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Credential | LCSW
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Telephone | 406-698-5299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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