MEDICARE: THREE RIVERS THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1225989924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE RIVERS THERAPY LLC

Provider Business Mailing Address
First Line	:	10434 CHERRY CREEK RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-8865
Country	:	US
Telephone Number	:	260-403-4252
Fax Number	:

Provider Business Practice Location Address
First Line	:	10434 CHERRY CREEK RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-8865
Country	:	US
Telephone Number	:	260-403-4252
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TINA MARIE PARKER
Credential	:	LMFT
Telephone Number	:	260-403-4252

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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